Continuous glucose monitoring counseling improves physical activity behaviors of individuals with type 2 diabetes: A randomized clinical trial. The Alberta Diabetes and Physical Activity Trial (ADAPT):A Randomized Trial Evaluating Theory-Based Interventions to Increase Physical Activity in Adults with Type 2 Diabetes Increasing Physical Activity in Belgian Type 2 Diabetes Patients: a Three-Arm Randomized Controlled Trial Comparative effectiveness of a mindful eating intervention to a diabetes self-management intervention among adults with type 2 diabetes: a pilot study. Effectiveness of a community health worker intervention among African American and Latino adults with type 2 diabetes: a randomized controlled trial. Effectiveness of a Group-Based Culturally Tailored Lifestyle Intervention Program on Changes in Risk Factors for Type 2 Diabetes among Asian Indians in the United States The effects of a supplemental, theory-based physical activity counseling intervention for adults with type 2 diabetes. Translating weight loss and physical activity programs into the community to preserve mobility in older, obese adults in poor cardiovascular health. Physical Activity/Exercise and Type 2 Diabetes A Self-Management Intervention for African Americans With Comorbid Diabetes and Hypertension: A Pilot Randomized Controlled Trial Design of a cluster-randomized controlled trial of a diabetes prevention program within African-American churches: The Fit Body and Soul study. Design features of the Diabetes and Periodontal Therapy Trial (DPTT): a multicenter randomized single-masked clinical trial testing the effect of nonsurgical periodontal therapy on glycosylated hemoglobin (HbA1c) levels in subjects with type 2 diabetes and chronic periodontitis. The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus A Community-Based Pilot Study of a Diabetes Pharmacist Intervention in Latinos: Impact on Weight and Hemoglobin A1c A pilot program for physical exercise promotion in adults with type 1 diabetes: the PEP-1 program. Roux-en-Y gastric bypass surgery or lifestyle with intensive medical management in patients with type 2 diabetes: feasibility and 1-year results of a randomized clinical trial. Sitagliptin improves albuminuria in patients with type 2 diabetes mellitus American College of Sports Medicine Position Stand. Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults. Lessened decline in physical activity and impairment of older adults with diabetes with telemedicine and pedometer use: results from the IDEATel study. Controlled outcome evaluation of the First Step Program: a daily physical activity intervention for individuals with type II diabetes The effect of nonsurgical periodontal therapy on hemoglobin A1c levels in persons with type 2 diabetes and chronic periodontitis: a randomized clinical trial. Effects of a Mediterranean-Style Diet on the Need for Antihyperglycemic Drug Therapy in Patients With Newly Diagnosed Type 2 Diabetes Five-year outcomes of patients with type 2 diabetes who underwent laparoscopic adjustable gastric banding.
AIMS Despite the known benefits , 60 % of individuals with diabetes do not engage in regular physical activity ( PA ) . This pilot study tested the effects of a counseling intervention using continuous glucose monitoring system ( CGMS ) feedback on PA self-efficacy , PA levels , and physiological variables . METHODS Adults ( N=52 ) with type 2 diabetes ( non-insulin requiring , inactive ) were r and omized to intervention ( n=27 ) or control ( n=25 ) groups . Both groups received 90min of diabetes education with a follow-up phone call 4 weeks later . The intervention group also received counseling derived from self-efficacy theory . This intervention included feedback on each participant 's CGMS graph and used role model CGMS graphs to clearly depict glucose reductions in response to PA . Outcomes were assessed at baseline and 8 weeks . RESULTS Participants receiving the intervention had higher self-efficacy scores than the control group for sticking to activity/resisting relapse at 8 weeks ( p<0.05 ) , indicating more confidence in maintaining a PA program . Intervention group participants light/sedentary activity minutes decreased significantly ( p<0.05 ) , moderate activity minutes increased significantly ( p<0.05 ) , and , HbA1c and BMI decreased significantly ( p<0.05 ) . CONCLUSIONS These data suggest that PA counseling interventions using CGMS feedback for individuals with type 2 diabetes may improve PA levels and reduce risk factors for diabetes-related complications Background Physical activity ( PA ) is associated with reduced morbidity and mortality in individuals with type 2 diabetes mellitus ( T2DM ) ; however , most T2DM adults are insufficiently active . Purpose To explore the effectiveness of two innovative/theoretically based behavioral-change strategies to increase PA and reduce hemoglobin A1c ( A1c ) in T2DM adults . Methods Participants ( n = 287 ) were r and omly assigned to a control group or an intervention group ( i.e. , print-based material s/pedometer group or print-based material s/pedometer plus telephone-counseling group ) . Changes in PA and A1c and other clinical measures were examined by Linear Mixed Model analyses over 18 months , along with moderating effects for gender and age . Results PA and A1c levels did not significantly change in intervention groups . Step counts significantly increased in the print-based material s and pedometer plus telephone counseling group , for women . Conclusions No significant effects were found for PA or A1c levels for T2DM adults . The multi-component strategy including telephone counseling may have potential for women . The trial was registered on Clinical Trials.gov identifier : NCT00221234 Background Pedometer-based physical activity programs have been typically delivered in a group format by a behavioral expert . An alternative strategy that builds on existing interactions is delivery through individual consultation by a general practitioner ( GP ) . These two delivery strategies have not been directly compared . Purpose To compare effectiveness of a 12-week physical activity ( PA ) intervention for type 2 diabetes patients delivered by a trained GP via an individual consultation or as group delivery by a behavioral expert . MethodS ixty-seven primary care participants ( mean age = 67.4 years , 70 % male ) from three Belgian general practice s were r and omized into three different treatment arms : ( 1 ) individual consultation ( n = 22 ) with three PA contacts with the patient 's GP ; ( 2 ) group counseling ( n = 21 ) with three PA group sessions delivered by a behavioral expert ; and ( 3 ) a control arm ( n = 24 ) receiving no intervention .  Participant inclusion criteria were ≤80 years ; 25–35 kg/m² ; ≤12 % HbA1c and reporting no PA limitations . Outcome measures were pedometer-determined steps/day , self-reported PA , and health parameters ( weight , body mass index , waist circumference , total cholesterol , fasting glucose , and HbA1c ) . Results Group counseling participants increased 1,706 steps/day over baseline significantly ( p ≤ 0.05 ) more than other treatment arms . Moreover , they increased their self-reported PA ( + 82 min/day ) , while control arm participants showed a decrease in PA ( p ≤ 0.05 ) . Participants of the individual consultation had a decrease in waist circumference ( −1.4 cm ) and HbA1c ( −0.32 % ) and a lower increase in total cholesterol ( + 7.2 mg/dl ) compared to the other treatment arms ( all p ≤ 0.05 ) . Conclusion Group counseling in type 2 diabetes patients improved PA , whereas individual consultations had an impact on some health outcomes on the short-term Mindful eating offers promise as an effective approach for weight management and glycemic control in people with diabetes .  Diabetes self-management education ( DSME ) is an essential component of effective self-care . Yet , little research has compared the effect of mindful eating to DSME-based treatment . This study compared the impact of these two interventions in adults with type 2 diabetes mellitus . A prospect i ve r and omized controlled trial with two parallel interventions was used . Participants included adults age 35 to 65 years with type 2 diabetes mellitus for 1 year or more , body mass index ( BMI ) of 27 or more , and hemoglobin A1c ( HbA1c ) of 7 % or more who were r and omly assigned to a 3-month mindful eating ( MB-EAT-D ; n=27 ) or Smart Choices ( SC ) DSME-based ( n=25 ) intervention . Follow-up occurred 3 months after intervention completion . Dietary intake , physical activity , weight , HbA1c and fasting plasma glucose , and fasting insulin were assessed using repeated measures analysis of variance with contrast analysis . There was no significant difference between groups in the change in weight or glycemia at study end . Significant difference occurred between groups in the change in dietary intake/1,000 kcal of trans fats , total fiber , and sugars ( all P<0.05 ) . Mean ( ± st and ard error ) reduction in weight ( -2.92 ± 0.54 kg for SC vs -1.53 ± 0.54 kg for MB-EAT-D ) and HbA1c ( -0.67 ± 0.24 % for SC and -0.83 ± 0.24 % for MB-EAT-D ) were significant ( P<0.01 ) . Significant reduction in energy intake and glycemic load occurred ( all P<0.0001 ) for both groups . Training in mindful eating and diabetes self-management  facilitate improvement in dietary intake , modest weight loss , and glycemic control . The availability of effective treatments gives patients with diabetes choices in meeting their self-care needs OBJECTIVES We tested the effectiveness of a culturally tailored , behavioral theory-based community health worker intervention for improving glycemic control . METHODS We used a r and omized , 6-month delayed control group design among 164 African American and Latino adult participants recruited from 2 health systems in Detroit , Michigan . Our study was guided by the principles of community-based participatory research . Hemoglobin A1c ( HbA1c ) level was the primary outcome measure . Using an empowerment-based approach , community health workers provided participants with diabetes self-management education and regular home visits , and accompanied them to a clinic visit during the 6-month intervention period . RESULTS Participants in the intervention group had a mean HbA1c value of 8.6 % at baseline , which improved to a value of 7.8 % at 6 months , for an adjusted change of -0.8 percentage points ( P < .01 ) . There was no change in mean HbA1c among the control group ( 8.5 % ) . Intervention participants also had significantly greater improvements in self-reported diabetes underst and ing compared with the control group . CONCLUSIONS This study contributes to the growing evidence for the effectiveness of community health workers and their role in multidisciplinary teams engaged in culturally appropriate health care delivery This study used an experimental , pretest-posttest control group repeated measures design to evaluate the effectiveness of a community-based culturally appropriate lifestyle intervention program to reduce the risk for type 2 diabetes ( T2DM ) among Gujarati Asian Indians ( AIs ) in an urban community in the US . Participants included 70 adult AIs in the greater Houston metropolitan area . The primary outcomes were reduction in weight and hemoglobin A1c ( HbA1c ) and improvement in physical activity . Participants were screened for risk factors and r and omly assigned to a 12-week group-based lifestyle intervention program ( n = 34 ) or a control group ( n = 36 ) that received st and ard print material on diabetes prevention . Participants also completed clinical measures and self-reported question naires about physical activity , social , and lifestyle habits at 0 , 3 , and 6 months . No significant baseline differences were noted between groups . While a significant decline in weight and increase in physical activity was observed in all participants , the intervention group lowered their HbA1c ( p < 0.0005 ) and waist circumference ( p = 0.04 ) significantly as compared to the control group . Findings demonstrated that participation in a culturally tailored , lifestyle intervention program in a community setting can effectively reduce weight , waist circumference , and HbA1c among Gujarati AIs living in the US BACKGROUND Physical activity ( PA ) is a cornerstone in the management of type 2 diabetes ( T2DM ) . This pilot investigation explores the effects of a st and ard diabetes education program compared with a supplemental PA intervention on diabetes-related health outcomes . METHODS Using a prospect i ve 2-armed design , 96 adults with T2DM were r and omly assigned to either st and ard care ( diabetes education program ; n = 49 ) or st and ard care supplemented with an 8-week , individualized-counseling and community-based PA component ( n = 47 ) . Measurements were taken at baseline , 3 , 6 , and 12 months . Primary outcomes were changes in PA ( self-report ) and HbA1c . Between group changes were compared using analysis of covariance ( ANCOVA ) and changes over time using repeated- measures ANOVA . RESULTS In comparison with st and ard care , the supplemental group demonstrated an increase in PA ( Ps < 0.01 ) and cardiorespiratory fitness ( Ps < 0.05 ) from baseline to all follow-up time-points . HbA1c levels declined ( P < .05 ) from baseline to all time points in the st and ard care group . Reduction in cholesterol-ratio ( P < .01 ) , increase in HDL ( P < .05 ) , and reductions in blood pressure , resting heart rate and BMI ( approaching statistical significance Ps < 0.10 ) were also reported for both groups . CONCLUSIONS PA counseling in addition to st and ard care is effective for promoting PA behavior change and positive health-related outcomes among individuals with T2DM BACKGROUND Limitations in mobility are common among older adults with cardiovascular and cardiometabolic disorders and have profound effects on health and well-being . With the growing population of older adults in the United States , effective and scalable public health approaches are needed to address this problem . Our goal was to determine the effects of a physical activity and weight loss intervention on 18-month change in mobility among overweight or obese older adults in poor cardiovascular health . METHODS The study design was a translational , r and omized controlled trial of physical activity ( PA ) and weight loss ( WL ) on mobility in overweight or obese older adults with cardiovascular disease ( CVD ) or at risk for CVD . The study was conducted within the community infrastructure of Cooperative Extension Centers . Participants were r and omized to 1 of 3 interventions : PA , WL + PA , or a successful aging ( SA ) education control arm . The primary outcome was time to complete a 400-m walk in seconds ( 400MWT ) . RESULTS A significant treatment effect ( P = .002 ) and follow-up testing revealed that the WL + PA group improved their 400MWT ( adjusted mean [ SE ] , 323.3 [ 3.7 ] seconds ) compared with both PA ( 336.3 [ 3.9 ] seconds ; P = .02 ) and SA ( 341.3 [ 3.9 ] seconds ; P < .001 ) . Participants with poorer mobility at baseline benefited the most ( P < .001 ) . CONCLUSION Existing community infrastructures can be effective in delivering lifestyle interventions to enhance mobility in older adults in poor cardiovascular health with deficits in mobility ; attention should be given to intervening on both weight and sedentary behavior since weight loss is critical to long-term improvement in mobility . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00119795 For decades , exercise has been considered a cornerstone of diabetes management , along with diet and medication . However , high- quality evidence on the importance of exercise and fitness in diabetes was lacking until recent years . The present document summarizes the most clinical ly relevant recent advances related to people with type 2 diabetes and the recommendations that follow from these . Our recently published technical review on physical activity/exercise and type 2 diabetes ( 1 ) includes greater detail on individual studies , on prevention of diabetes , and on the physiology of exercise . The present statement focuses on type 2 diabetes . Issues primarily germane to type 1 diabetes will be covered in a subsequent technical review and ADA Statement . The levels of evidence used are defined by the ADA in ref . 2 . Two r and omized trials each found that lifestyle interventions including ∼150 min/week of physical activity and  diet-induced weight loss of 5–7 % reduced the risk of progression from impaired glucose tolerance ( IGT ) to type 2 diabetes by 58 % ( 3,4 ) . A cluster-r and omized trial found that diet alone , exercise alone , and combined diet and exercise were equally effective in reducting the progression from IGT to diabetes ( 5 ) . Therefore , there is firm and consistent evidence that programs of increased physical activity  and modest weight loss reduce the incidence of type 2 diabetes in individuals with IGT . Boule et al. ( 6 ) undertook a systematic review and meta- analysis on the effects of structured exercise interventions in clinical trials of ≥8 weeks duration on HbA1c ( A1C ) and body mass in people with type 2 diabetes . Postintervention A1C was significantly lower in exercise than control groups ( 7.65 vs. 8.31 % , weighted mean difference −0.66 % ; P < 0.001 ) . In contrast , postintervention body weight did not differ between the exercise and control groups . Meta-regression confirmed that the beneficial effect of exercise on A1C Introduction The objective of this pilot 6-month r and omized controlled trial was to determine the effectiveness of an intensive , community-based , group intervention that focused on diet , physical activity , and peer support for reducing weight among urban-dwelling African Americans with comorbid type 2 diabetes and hypertension . Methods Sixty-one participants were r and omized into an intervention or control group . The 6-month intervention consisted of 18 group sessions led by a dietitian in a community setting and weekly telephone calls from a peer supporter . The intervention featured culturally tailored nutrition education , behavioral skills training , and social support focused on changes to diet and physical activity . The control group consisted of two 3-hour group sessions of diabetes self-management education taught by a community health worker . Outcome measures were assessed at baseline and 6 months . The primary outcome was achievement of a 5 % weight reduction at 6 months . A secondary outcome was achievement of a 0.5 percentage-point reduction in hemoglobin A1c ( HbA1c ) . Results Groups did not differ in achievement of the weight-loss goal . Intervention participants  lost a mean of 2.8 kg ( P = .01 ) ; control participants did not lose a significant amount of weight . A greater proportion of intervention ( 50.0 % ) than control ( 21.4 % ) participants reduced HbA1c by 0.5 percentage points or more at 6 months ( P = .03 ) . Conclusion The intervention was more effective than usual care ( short-term diabetes education ) at improving glycemic control , but not weight , in low-income African Americans with comorbid diabetes and hypertension . A community-based 6-month group class with culturally tailored education , behavioral skills training , and peer support can lead to a clinical ly significant reduction in HbA1c Evidence from varied community setting s has shown that the Group Lifestyle Balance ( GLB ) Program and other adaptations of the Diabetes Prevention Program ( DPP ) intervention are effective in lowering diabetes risk . Most DPP data originated from studies of pre-diabetic whites , with only sparse evidence of the effect of DPP in African Americans ( AAs ) in community setting s. This paper describes the design , methods , baseline characteristics and cost effective measures , of a single-blinded , cluster-r and omized trial of a faith-based adaptation of the GLB program , Fit Body and Soul ( FBAS ) . The major aims are to test efficacy and cost utility of FBAS in twenty AA churches . R and omization occurred at the church level and 604 AA overweight/obese ( BMI ≥25kg/m(2 ) ) adults with fasting plasma glucose range from normal to pre-diabetic received either FBAS or a health-education comparison program . FBAS is a group-based , multi-level intervention delivered by trained church health advisors ( health professionals from within the church ) , with the goal of ≥7 % weight loss , achieved through increasing physical activity , healthy eating and behavior modification . The primary outcome is weight change at 12weeks post intervention . Secondary outcomes include hemoglobin A1C , fasting plasma glucose , waist circumference , blood pressure , physical activity level , quality of life measures , and cost-effectiveness . FBAS is the largest known cohort of AAs enrolled in a faith-based DPP translation . Reliance on health professionals from within the church for program implementation and the cost analysis are unique aspects of this trial . The design provides a model for faith-based DPPs and holds promise for program sustainability and widespread dissemination BACKGROUND Evidence suggests that periodontitis is associated with prevalent and incident type 2 diabetes mellitus ( T2DM ) , raising the question of whether periodontitis treatment may improve glycemic control in patients with T2DM . Meta-analyses of mostly small clinical trials suggest that periodontitis treatment results in a modest reduction in glycosylated hemoglobin ( Hb ) A1c . PURPOSE The purpose of the Diabetes and Periodontal Therapy Trial ( DPTT ) was to determine if periodontal treatment reduces HbA1c in patients with T2DM and periodontitis . METHODS DPTT was a phase-III , single-masked , multi-center , r and omized trial with a planned enrollment of 600 participants . Participants were r and omly assigned to receive periodontal treatment immediately ( Treatment Group ) or after 6 months ( Control Group ) . HbA1c values and clinical periodontal measures were determined at baseline and 3 and 6 months following r and omization . Medication usage and dosing were assessed at each visit . Periodontal treatment consisted of scaling and root planing for a minimum of two 90-minute sessions , plus the use of an antibacterial mouth rinse for at least 32 days afterwards . The primary outcome was change in HbA1c from baseline to 6 months and the trial was powered to detect a between-group difference of 0.6 % . Secondary outcomes included changes in periodontal clinical measures , fasting plasma glucose , the Homeostasis Model Assessment ( HOMA2 ) and the need for rescue diabetes or periodontal therapy . CONCLUSION Dental and medical research ers collaborated to recruit , treat and monitor participants with two chronic diseases to determine if treatment of one condition affects the status of the other Objective Dietary carbohydrate is the major determinant of postpr and ial glucose levels , and several clinical studies have shown that low-carbohydrate diets improve glycemic control . In this study , we tested the hypothesis that a diet lower in carbohydrate would lead to greater improvement in glycemic control over a 24-week period in patients with obesity and type 2 diabetes mellitus . Research design and methods Eighty-four community volunteers with obesity and type 2 diabetes were r and omized to either a low-carbohydrate , ketogenic diet ( < 20 g of carbohydrate daily ; LCKD ) or a low-glycemic , reduced-calorie diet ( 500 kcal/day deficit from weight maintenance diet ; LGID ) . Both groups received group meetings , nutritional supplementation , and an exercise recommendation . The main outcome was glycemic control , measured by hemoglobin A1c . Results Forty-nine ( 58.3 % ) participants completed the study . Both interventions led to improvements in hemoglobin A1c , fasting glucose , fasting insulin , and weight loss . The LCKD group had greater improvements in hemoglobin A1c ( -1.5 % vs. -0.5 % , p = 0.03 ) , body weight ( -11.1 kg vs. -6.9 kg , p = 0.008 ) , and high density lipoprotein cholesterol ( + 5.6 mg/dL vs. 0 mg/dL , p < 0.001 ) compared to the LGID group . Diabetes medications were reduced or eliminated in 95.2 % of LCKD vs. 62 % of LGID participants ( p < 0.01 ) . Conclusion Dietary modification led to improvements in glycemic control and medication reduction/elimination in motivated volunteers with type 2 diabetes . The diet lower in carbohydrate led to greater improvements in glycemic control , and more frequent medication reduction/elimination than the low glycemic index diet . Lifestyle modification using low carbohydrate interventions is effective for improving and reversing type 2 diabetes Type 2 diabetes disproportionately affects Latinos increasing their risk of diabetes-related complications . This study used a r and omized controlled design with a community-based approach to evaluate the impact of a culturally tailored pharmacist intervention on clinical outcomes in Latino diabetics . The intervention included a focused discussion and two individual pharmacist counseling sessions on medication , nutrition , exercise , and self-care to promote behavior changes . Sessions were culturally adapted for language , diet , family participation , and cultural beliefs . Clinical outcomes were measured at baseline and three months . Nineteen intervention and 24 control participants completed the study . Mean BMI reduction was greater for intervention than for control group participants ( –0.73± 0.07 kg/m2 versus + 0.37±0.02 kg/m2 p<.009 respectively ) . Hemoglobin A1c was significantly reduced by 0.93±0.45 % in the intervention group only . There was no significant difference in blood glucose , blood pressure , or lipid levels . An innovative culturally-sensitive pharmacist intervention improved selected clinical outcomes among Latino diabetics Physical inactivity is highly common in adults with type 1 diabetes ( T1D ) as specific barriers ( i.e. , hypoglycemia ) may prevent them from being active . The objective of this study was to examine the efficacy of the Physical Exercise Promotion program in type 1 diabetes ( PEP-1 ) program , a group program of physical activity ( PA ) promotion ( intervention ) compared with an information leaflet ( control ) , to improve total energy expenditure ( TEE ) in adults with T1D after 12 weeks . TEE was measured with a motion sensor over a 7-day period at inclusion , after the program ( 12 weeks ) and 1-year after inclusion . The 12 weekly sessions of the program included a 30-min information session ( glycemic control and PA ) and 60 min of PA .  A total of 48 adults , aged 18 to 65 years with a reported PA practice < 150 min per week , were recruited ( 45.8 % men ; aged 44.6 ± 13.3 years ; 8.0 % ± 1.1 % glycated hemoglobin ( A1c ) ) and r and omized in this pilot trial . Ninety percent of participants completed the program and 88 % completed the 1-year follow-up . No change was observed for TEE and A1c in both groups . After the 12-week program , the mean peak oxygen uptake increased ( 14 % ; p = 0.003 ) in the intervention group ; however , at the 1-year follow-up , it was no longer different from baseline . In the control group , no difference was observed for the peak oxygen uptake . These results suggest that the PEP-1 pilot program could increase cardiorespiratory fitness . However , this benefit is not sustained over a long-term period . The PEP-1 program did not increase TEE in patients with T1D and other strategies remain necessary to counteract physical inactivity in this population IMPORTANCE Emerging data support bariatric surgery as a therapeutic strategy for management of type 2 diabetes mellitus . OBJECTIVE To test the feasibility of methods to conduct a larger multisite trial to determine the long-term effect of Roux-en-Y gastric bypass ( RYGB ) surgery compared with an intensive diabetes medical and weight management ( Weight Achievement and Intensive Treatment [ Why WAIT ] ) program for type 2 diabetes . DESIGN , SETTING , AND PARTICIPANTS A 1-year pragmatic r and omized clinical trial was conducted in an academic medical institution . Participants included persons aged 21 to 65 years with type 2 diabetes diagnosed more than 1 year before the study ; their body mass index was 30 to 42 ( calculated as weight in kilograms divided by height in meters squared ) and hemoglobin A1c ( HbA1c ) was greater than or equal to 6.5 % . All participants were receiving antihyperglycemic medications . INTERVENTIONS RYGB ( n = 19 ) or Why WAIT ( n = 19 ) including 12 weekly multidisciplinary group lifestyle , medical , and educational sessions with monthly follow-up thereafter . MAIN OUTCOMES AND MEASURES Proportion of patients with fasting plasma glucose levels less than 126  mg/dL  and HbA1c less than 6.5 % , measures of cardiometabolic health , and patient-reported outcomes . RESULTS At 1 year , the proportion of patients achieving HbA1c below 6.5 % and fasting glucose below 126 mg/dL was higher following RYGB than Why WAIT ( 58 % vs 16 % , respectively ; P = .03 ) . Other outcomes , including HbA1c , weight , waist circumference , fat mass , lean mass , blood pressure , and triglyceride levels , decreased and high-density lipoprotein cholesterol increased more after RYGB compared with Why WAIT . Improvement in cardiovascular risk scores was greater in the surgical group . At baseline the participants exhibited moderately low self-reported quality -of-life scores reflected by Short Form-36 total , physical health , and mental health , as well as high Impact of Weight on Quality of Life-Lite and Problem Areas in Diabetes health status scores . At 1 year , improvements in Short Form-36 physical and mental health scores and Problem Areas in Diabetes scores did not differ significantly between groups . The Impact of Weight on Quality of Life-Lite score improved more with RYGB and correlated with greater weight loss compared with Why WAIT . CONCLUSIONS AND RELEVANCE In obese patients with type 2 diabetes , RYGB produces greater weight loss and sustained improvements in HbA1c and cardiometabolic risk factors compared with medical management , with emergent differences over 1 year . Both treatments improve general quality -of-life measures , but RYGB provides greater improvement in the effect of weight on quality of life . These differences may help inform therapeutic decisions for diabetes and weight loss strategies in obese patients with type 2 diabetes until larger r and omized trials are performed . TRIAL REGISTRATION clinical trials.gov Identifier : NCT01073020 Abstract Introduction The aim of the present study was to determine the effect of sitagliptin on microalbuminuria in patients with type 2 diabetes mellitus . Material s and Methods A total of 85 patients with type 2 diabetes mellitus ( age > 20 years , < 80 years , hemoglobin A1c [ HbA1c ] < 8.4 % ) were r and omized to patients taking sitagliptin 50 mg or other oral glucose‐lowering agents .  The following parameters were evaluated at 0 , 3 and 6 months after the treatment : bodyweight , blood pressure , HbA1c , fasting plasma glucose , fasting plasma insulin , low‐density lipoprotein cholesterol , high‐density lipoprotein cholesterol , triglycerides , estimated glomerular filtration rate and urinary albumin excretion . The primary outcome was changes in urinary albumin excretion at 6 months . Results Significant and comparable falls in HbA1c and fasting plasma glucose were found in both groups . However , sitagliptin significantly reduced urinary albumin excretion within 6 months , especially in patients with high urinary albumin at baseline . A total of 27 patients with normoalbuminuria showed a reduction in urinary albumin excretion , suggesting that sitagliptin prevents the development of albuminuria . A total of 15 patients with albuminuria  showed a reduction in urinary albumin excretion , suggesting the beneficial effect of sitagliptin in the early stage of diabetic nephropathy . There was a significant correlation between improvement of proteinuria and that of diastolic blood pressure . Conclusions The results suggested that sitagliptin improved albuminuria , in addition to improving glucose . The mechanism of the reduction of albuminuria by sitagliptin could be a direct effect , as well as an increase in active glucagon‐like peptide‐1 , independently affecting blood pressure , bodyweight and glucose metabolism . This trial was registered with the University Hospital Medical Information Network ( UMIN no. # 000010871 ) Overweight and obesity affects more than 66 % of the adult population and is associated with a variety of chronic diseases . Weight reduction reduces health risks associated with chronic diseases and is therefore encouraged by major health agencies . Guidelines of the National Heart , Lung , and Blood Institute ( NHLBI ) encourage a 10 % reduction in weight , although considerable literature indicates reduction in health risk with 3 % to 5 % reduction in weight . Physical activity ( PA ) is recommended as a component of weight management for prevention of weight gain , for weight loss , and for prevention of weight regain after weight loss . In 2001 , the American College of Sports Medicine ( ACSM ) published a Position St and that recommended a minimum of 150 min wk(-1 ) of moderate-intensity PA for overweight and obese adults to improve health ; however , 200 - 300 min wk(-1 ) was recommended for long-term weight loss . More recent evidence has supported this recommendation and has indicated more PA may be necessary to prevent weight regain after weight loss . To this end , we have reexamined the evidence from 1999 to determine whether there is a level at which PA is effective for prevention of weight gain , for weight loss , and prevention of weight regain . Evidence supports moderate-intensity PA between 150 and 250 min wk(-1 ) to be effective to prevent weight gain .  Moderate-intensity PA between 150 and 250 min wk(-1 ) will provide only modest weight loss . Greater amounts of PA ( > 250 min wk(-1 ) ) have been associated with clinical ly significant weight loss .  Moderate-intensity PA between 150 and 250 min wk(-1 ) will improve weight loss in studies that use moderate diet restriction but not severe diet restriction . Cross-sectional and prospect i ve studies indicate that after weight loss , weight maintenance is improved with PA > 250 min wk(-1 ) . However , no evidence from well- design ed r and omized controlled trials exists to judge the effectiveness of PA for prevention of weight regain after weight loss .  Resistance training does not enhance weight loss but may increase fat-free mass and increase loss of fat mass and is associated with reductions in health risk . Existing evidence indicates that endurance PA or resistance training without weight loss improves health risk . There is inadequate evidence to determine whether PA prevents or attenuates detrimental changes in chronic disease risk during weight gain OBJECTIVE to examine the effects of the Informatics for Diabetes Education and Telemedicine ( IDEATel ) telemedicine intervention and pedometer use on physical activity ( PA ) and impairment in older adults with diabetes . DESIGN r and omised clinical trial . Subjects ethnically diverse medically underserved Medicare beneficiaries with diabetes ( n= 1,650 ) . METHODS participants received home videovisits with a diabetes educator every 4 - 6 weeks or usual care . All received a pedometer . Annual measurements included hemoglobin A1c , Comprehensive Assessment and Referral Evaluation Activities of Daily Living , Diabetes Self-Care Activities , Charlson Comorbidity Index , Luben Social Support and pedometer use . Mixed model analyses were performed using r and om effects to adjust for clustering within primary care physicians . RESULTS in the telemedicine group compared with the usual care group , the rate of decline in PA ( P= 0.0128 ) and physical impairment ( PI ) ( P= 0.0370 ) was significantly less over time . Significant mean endpoint differences were observed for PA ( P= 0.003 ) . Pedometer use was significantly associated with PA ( P= 0.0006 ) and PI ( P < 0.0001 ) . Baseline characteristics associated with greater PA included having fewer comorbid conditions ( P= 0.0054 ) , less depression ( P < 0.0001 ) , more social networking ( P < 0.0001 ) , lower BMI ( P < 0.0001 ) , male gender ( P < 0.0001 ) and lower hemoglobin A1c level ( P= 0.0045 ) . Similar predictors were observed for PI , except duration of diabetes also predicted increased impairment ( P < 0.0001 ) . Significant indirect effects were observed through use of the pedometer on reduced decline in PA ( P= 0.0024 , 0.0013 ) and PI ( P= 0.0024 , P < 0.0001 ) . CONCLUSIONS this telemedicine intervention reduced rates of decline in PA and impairment in older adults with diabetes . Pedometers may be a helpful inexpensive adjunct to diabetes initiatives delivered remotely with emerging technologies . Clinical Trials.gov identifier NCT 00271739 OBJECTIVE : To conduct a r and omised trial of a physical activity ( PA ) intervention , The First Step Program ( FSP ) for adults with type II diabetes . DESIGN : A 16-week intervention study and 24-week follow-up assessment . PARTICIPANTS : A total of 47 overweight/obese , sedentary individuals ( age=52.7±5.2 y ; BMI = 33.3±5.6 kg/m2 ) recruited through a diabetes education centre . MEASUREMENTS : Primary outcome :  daily PA assessed by pedometer ( steps/day ) . Secondary outcomes : anthropometric measures ( weight , BMI , waist girth , hip girth ) ; indicators of cardiovascular health ( resting heart rate and blood pressure ) ; glycemic control ( fasting glucose , insulin , HbA1c , glucose concentration 120 min postglucose load ) ; plasma lipid status ( total cholesterol , HDL cholesterol , LDL cholesterol , and triglycerides ) . RESULTS : Relative to the CONTROL group , FSP participants increased  their PA > 3000 steps/day ( approximately 30 min/day ) during the intervention ( P<0.0001 ) . Waist and hip girth decreased ( approximately 2–3 cm ) , but did not differ significantly between groups . Significant changes did not emerge for any of the other variables . CONCLUSIONS : The FSP is a practical intervention that elicits an immediate and profound change in walking behaviour . Such change is an important ‘ first step ’ towards increasing the volume and /or intensity of PA necessary to improve long-term health outcomes in this largely sedentary and overweight or obese population . Relapse by 24 weeks indicates that other strategies such as booster sessions are needed to maintain lifestyle change . Further research must determine realistic and responsive health outcomes for this population that are achievable through practical , real-world programming IMPORTANCE Chronic periodontitis , a destructive inflammatory disorder of the supporting structures of the teeth , is prevalent in patients with diabetes . Limited evidence suggests that periodontal therapy may improve glycemic control . OBJECTIVE To determine if nonsurgical periodontal treatment reduces levels of glycated hemoglobin ( HbA1c ) in persons with type 2 diabetes and moderate to advanced chronic periodontitis . DESIGN , SETTING , AND PARTICIPANTS The Diabetes and Periodontal Therapy Trial ( DPTT ) , a 6-month , single-masked , multicenter , r and omized clinical trial . Participants had type 2 diabetes , were taking stable doses of medications , had HbA1c levels between 7 % and less than 9 % , and untreated chronic periodontitis . Five hundred fourteen participants were enrolled between November 2009 and March 2012 from diabetes and dental clinics and communities affiliated with 5 academic medical centers . INTERVENTIONS The treatment group ( n = 257 ) received scaling and root planing plus chlorhexidine oral rinse at baseline and supportive periodontal therapy at 3 and 6 months . The control group ( n = 257 ) received no treatment for 6 months . MAIN OUTCOMES AND MEASURES Difference in change in HbA1c level from baseline between groups at 6 months . Secondary outcomes included changes in probing pocket depths , clinical attachment loss , bleeding on probing , gingival index , fasting glucose level , and Homeostasis Model Assessment ( HOMA2 ) score . RESULTS Enrollment was stopped early because of futility . At 6 months , mean HbA1c levels in the periodontal therapy group increased 0.17 % ( SD , 1.0 ) , compared with 0.11 % ( SD , 1.0 ) in the control group , with no significant difference between groups based on a linear regression model adjusting for clinical site ( mean difference , -0.05 % [ 95 % CI , -0.23 % to 0.12 % ] ; P = .55 ) . Periodontal measures improved in the treatment group compared with the control group at 6 months , with adjusted between-group differences of 0.28 mm ( 95 % CI , 0.18 to 0.37 ) for probing depth , 0.25 mm ( 95 % CI , 0.14 to 0.36 ) for clinical attachment loss , 13.1 % ( 95 % CI , 8.1 % to 18.1 % ) for bleeding on probing , and 0.27 ( 95 % CI , 0.17 to 0.37 ) for gingival index ( P < .001 for all ) . CONCLUSIONS AND RELEVANCE Nonsurgical periodontal therapy did not improve glycemic control in patients with type 2 diabetes and moderate to advanced chronic periodontitis . These findings do not support the use of nonsurgical periodontal treatment in patients with diabetes for the purpose of lowering levels of HbA1c . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00997178 Context Mediterranean-style diets improve control of coronary risk factors and hyperglycemia , but few direct comparisons of the diet with other st and ard diets have been done . Contribution In this r and omized clinical trial , patients with newly diagnosed type 2 diabetes who were assigned to a low-carbohydrate , Mediterranean-style diet had better glycemic control and were less likely to need oral antihyperglycemic therapy than patients assigned to a low-fat diet . Caution The trial was unblinded , and dietary intake was self-reported . Implication A low-carbohydrate , Mediterranean-style diet seems to be preferable to a low-fat diet for glycemic control in patients with newly diagnosed type 2 diabetes . The Editors The p and emic of type 2 diabetes is an enormous public health problem , with 380 million cases worldwide projected by 2025 ( 1 , 2 ) . Lifestyle intervention studies ( 3 ) have demonstrated large reductions in risk for type 2 diabetes that remain after lifestyle counseling is stopped ( 4 , 5 ) . Despite this beneficial effect , the American Diabetes Association ( ADA ) recommends that patients with newly diagnosed type 2 diabetes be treated with pharmacotherapy as well as lifestyle changes ( 6 ) . The rationale for combination therapy is presumably that each form of treatment alone is imperfect . Lifestyle changes are often inadequate because patients do not lose weight or regain weight or their diabetes worsens independent of weight ( 6 ) . Pharmacotherapy also often fails with time ( 7 ) , and some drugs have associated cardiovascular and other risks ( 8 , 9 ) . For those reasons , lifestyle changes proven to be more effective than what is typically recommended would be welcome . For example , Mediterranean-style ( MED ) diets with a high proportion of monounsaturated fat provide cardiovascular benefits and increase insulin sensitivity ( 1012 ) , and the ADA recommends low-carbohydrate or low-fat , calorie-restricted diets for weight loss in overweight and obese patients with type 2 diabetes ( 13 ) . However , few direct , long-term comparisons of the 2 diets in patients with diabetes have been done ( 11 ) . We conducted a r and omized trial to compare the effectiveness , durability , and safety of a low-carbohydrate MED diet and a low-fat diet on glycemic control in patients with newly diagnosed type 2 diabetes . Methods We conducted the trial between January 2004 ( first patient enrolled ) and September 2008 ( end of follow-up of the last patient ) at the research center of the Diabetes Clinic of the Azienda Ospedaliera Universitaria , Second University of Naples , Naples , Italy , in accordance with the Declaration of Helsinki and with the institutional review board 's approval . Screening Phase We recruited men and women with newly diagnosed type 2 diabetes by ADA criteria who had never been treated with antihyperglycemic drugs from the clinical practice s of trial investigators and screened them for eligibility . Inclusion criteria were age 30 to 75 years , body mass index ( BMI ) greater than 25 kg/m2 , and hemoglobin A1c ( HbA1c ) level less than 11 % . Participants also had to be sedentary ( < 1 hour of physical activity per week ) with no evidence of participation in weight-reduction programs and with a stable weight ( 2 kg ) in the past 6 months . Exclusion criteria included pregnancy or breastfeeding , use of any investigational drug in the previous 3 months , use of agents affecting glycemic control ( such as systemic glucocorticoids and weight loss drugs ) , and any condition that might compromise adherence to diet regimens . To minimize the likelihood of including participants with late-onset type 1 diabetes , we screened c and i date s by testing for antibodies to glutamate decarboxylase and measuring fasting plasma C-peptides . We excluded patients with positive antibodies or C-peptide levels less than 0.25 pmol/L ( < 0.76 ng/L ) . We also excluded patients with abnormal laboratory test results , including liver enzyme levels ( alanine aminotransferase , aspartate aminotransferase , and alkaline phosphatase ) greater than 3 times the upper limit of normal and serum creatinine levels greater than 123.8 mol/L ( > 1.4 mg/dL ) . We required that participants successfully self-monitor their diet and physical activity over a 2-week run-in period . We provided dietary education during that time that emphasized the importance of eating a healthy diet and being physically active for both weight loss and improvement of glycemic control . Participants were also taught to prepare their own meals at home . We encouraged all individuals who smoked to quit and provided self-help material s , referral to local programs , or both , as appropriate . R and omization and Blinding After obtaining informed consent , we r and omly assigned patients to 1 of the 2 study diets by using a computer-generated r and om-number sequence ( simple r and omization ) . Allocation was concealed in sealed study folders that were held in a central , secured location until after informed consent was obtained . The nurses who scheduled the study visits did not have access to the r and omization list , and laboratory staff did not know the participants ' group assignments . Staff members involved in the intervention were aware of group assignments , but those who assessed achievement of the primary outcome were blinded to the intervention . Participants received no financial compensation or gifts . Dietary Interventions We r and omly assigned patients to a low-carbohydrate MED diet or to a low-fat diet . The MED diet was rich in vegetables and whole grains and low in red meat , which was replaced with poultry and fish . We restricted energy intake to 1500 kcal/d for women and 1800 kcal/d for men , with the goal of no more than 50 % of calories from complex carbohydrates , based on evidence that , in the context of a MED diet , a carbohydrate content less than 50 % of daily energy is more beneficial than higher content for weight loss and cardiovascular risk reduction ( 14 ) . The diet had no less than 30 % calories from fat . The main source of added fat was 30 to 50 g of olive oil . The low-fat diet was based on American Heart Association guidelines ( 15 ) ; it was rich in whole grains and restricted additional fats , sweets , and high-fat snacks . We restricted energy intake to 1500 kcal/d for women and 1800 kcal/d for men , with the goal of no more than 30 % of calories from fat and no more than 10 % of calories from saturated fat . Nutritionists and dietitians gave dietary advice to participants in both groups in monthly sessions in the first year and bimonthly sessions thereafter . Participants kept diet diaries after being instructed how to record their intake using food models as examples of portion size and using actual weights or amounts in terms of common measures ( such as cups , teaspoons , and dessert spoons ) . We assessed adherence to the diets by session attendance and review of the diaries . Nondietary Interventions Patients in both groups also received guidance on increasing their level of physical activity , mainly walking for a minimum of 30 minutes per day , but also swimming or aerobic ball games . The physical activity program relied heavily on home-based exercise with gradual progression toward a goal of 175 minutes of moderate-intensity physical activity per week . Although walking was encouraged , participants were allowed to choose other types of moderate-intensity physical activity , and programs were tailored on the basis of the results of a baseline physical fitness test and safety concerns . We asked all patients to record occupational , household , and leisure time physical activity . Outcomes We followed patients for 4 years to assess trial outcomes . The primary outcome measure was time to introduction of antihyperglycemic drug therapy . Trial investigators were responsible for initiating drug therapy by the following protocol . As suggested by the ADA for clinical evaluation and management of diabetic patients ( 16 ) , we measured HbA1c at baseline and every 3 months thereafter . Participants who had a HbA1c level greater than 7 % were given an additional 3 months to reinforce dietary guidance and physical activity ; if the HbA1c level remained greater than 7 % , a drug regimen was introduced . Participants with an HbA1c level greater than 7 % at baseline were counted as having experienced the primary outcome if they still had that level at first follow-up . Trial investigators were also responsible for initiating or titrating antihypertensive or lipid-lowering therapy . Secondary outcome measures were changes in weight ( including BMI and waist circumference ) , glycemic control ( HbA1c , glucose , serum insulin , and adiponectin levels and homeostasis model assessment of insulin sensitivity ) , coronary risk factors ( lipid levels and blood pressure ) , and medications and meeting ADA coronary risk factor goals ( HbA1c level < 7 % , blood pressure < 130/80 mm Hg , and low-density lipoprotein cholesterol level < 2.59 mmol/L [ < 100 mg/dL ] ) ( 16 ) . Participants were weighed without shoes and in lightweight clothing to the nearest 0.1 kg at baseline and every month . Height at baseline ( for calculation of BMI ) was measured to the nearest millimeter with the use of a wall-mounted stadiometer ( Seca , Hamburg , Germany ) . Waist circumference was measured halfway between the last rib and the iliac crest . We measured HbA1c levels with high-pressure liquid chromatography by using the fully automated Glycosylated Hemoglobin Analyzer System ( Bio-Rad , Hercules , California ) traceable to the Diabetes Control and Complications Trial reference method , with a reference range of 4.0 % to 6.0 % . Insulin sensitivity in the fasting state was assessed with homeostasis model assessment and calculated with the following formula , as described by Matthews and colleagues ( 17 ) : fasting plasma glucose (mmol/L)fasting serum insulin (U/mL)/25 . High scores indicate low insulin sensitivity ( insulin resistance ) . We assayed plasma insulin and adiponectin levels by radioimmunoassay , as described elsewhere ( 18 ) . We performed assays for serum BACKGROUND Evidence of the positive effects of gastric b and ing on patients with diabetes has continued to increase . The long-term follow-up of such patients , however , has been limited . The purpose of the present study was to provide the long-term outcomes of patients with diabetes undergoing laparoscopic adjustable gastric b and ing at our institution . METHODS From January 2002 through June 2004 , 102 patients with type 2 diabetes mellitus underwent laparoscopic adjustable gastric b and ing .  The study parameters included preoperative age , gender , race , body mass index , duration of diabetes before surgery , fasting glucose level , hemoglobin A1c ( HbA1c ) , and medications used . Preoperative data from all patients were collected prospect ively and entered into an institutional review board-approved data base . Beginning in 2008 , efforts were made to collect the 5-year follow-up data . RESULTS Of the 102 patients , 7 were excluded because they had not reached the 5-year follow-up point ( 2 patients had had the b and removed early and 5 patients had died ; 2 of cancer and 3 of unknown causes ) , leaving 95 patients for the present study . The mean preoperative age was 49.3 years ( range 21.3 - 68.4 ) . The mean preoperative body mass index was 46.3 kg/m(2 ) ( range 35.1 - 71.9 ) and had decreased to 35.0 kg/m(2 ) ( range 21.1 - 53.7 ) by 5 years of follow-up , yielding a mean percentage of excess weight loss of 48.3 % . The mean duration of the diabetes diagnosis before surgery was 6.5 years . Of 94 patients , 83 ( 88.3 % ) were taking medications preoperatively , with 14.9 % overall taking insulin . At 5 years postoperatively , 33 ( 46.5 % ) of 71 patients were taking medications , with 8.5 % taking insulin . The mean fasting preoperative glucose level was 146.0 mg/dL. The glucose level had decreased to 118.5 mg/dL at 5 years postoperatively ( P = .004 ) . The mean HbA1c level was 7.53 preoperatively in 72 patients and was 6.58 at 5 years postoperatively in 64 patients ( P < .001 ) . Overall , diabetes had resolved ( no medication requirement , with HbA1c < 6 and /or glucose < 100 mg/dL ) in 23 ( 39.7 % ) of 58 patients and had improved ( use of fewer medications and /or fasting glucose levels of 100 - 125 mg/dL ) in 41 ( 71.9 % ) of 57 patients . The combined improvement/remission rate was 80 % ( 64 of 80 patients ) . CONCLUSION Our data have demonstrated that laparoscopic adjustable gastric b and ing results in a substantial sustained positive effect on diabetes in morbidly obese patients , with a significant reduction in HbA1c and an 80 % overall rate of improvement/remission
The findings demonstrate community-based PA interventions can be effective in producing increases in PA .
Our findings can guide future PA community-based interventions  in adult population s diagnosed with TD2
Evidence suggests engaging in regular physical activity ( PA ) can have beneficial outcomes for adults with type 2 diabetes ( TD2 ) , including weight loss , reduction of medication usage and improvements in hemoglobin A1c (HbA1c)/fasting glucose .
While a number of clinical -based PA interventions exist , community-based approaches are limited .