MedicalResearch.com Interview with Andy Menke PhD
Department of Epidemiology, Tulane University School of Medicine
New Orleans, Louisiana
Medical Research: What are the main findings of the study?Dr. Menke:The prevalence of diabetes increased more in men than women between 1976 and 2010 in the US, from 4.7% to 11.2% in men and from 5.7% to 8.7% in women. Changes over time in the distribution of age, race/ethnicity, and obesity in the population explained all of the increase in women and only half of the increase in men.
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MedicalResearch.com Interview with: Jordi Salas-Salvadó MD PhD
Physiopathology of Obesity and Nutrition
Institute of Health Carlos III, Madrid, Spain
Medical Research: What are the main findings of the study?Dr. Salas-Salvadó:The main finding of our study is that an increase in albumin-adjusted serum calcium increases the risk of type 2 diabetes in Mediterranean individuals at high cardiovascular risk. This association remained significant even after taking classic risk factors into account. To the best of our knowledge this is the first study assessing the association between changes in serum calcium levels and the risk of type 2 diabetes development.
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MedicalResearch.com Interview with: Dr. Sabita Soedamah-Muthu
Division of Human Nutrition,Wageningen University
Wageningen, the Netherlands
and Prof Trevor Orchard
Department of Epidemiology,
Graduate School of Public Health,
University of Pittsburgh, Pittsburgh, PA, USAMedical Research: What are the main findings of the study?Answer: We present a new prognostic model combining information on age, glycated haemoglobin, waist-hip ratio, albumin/creatinine ratio and HDL (good) cholesterol to assess the 3, 5 and 7 year risk of developing major outcomes in patients with type 1 diabetes.
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MedicalResearch.com Interview with: Dr. Frank B. Hu
Department of Nutrition
Harvard School of Public Health
Boston, MA
Medical Research: What are the main findings of the study?Dr. Hu:in this study among approximately 5000 patients with type 2 diabetes followed for up to 10 years, longer duration of sulfonylurea therapy was associated with a higher risk of coronary heart disease. The continuous sulfonylurea therapy for 10 years was associated with almost two times greater risk of coronary heart disease compared with nonusers. However, given the observational nature of the study, we cannot make causal inference from these findings.
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MedicalResearch.com Interview with: Satyesh K Sinha, PhD
Assistant Professor
Charles R Drew University of Medicine and Science
Los Angeles, CA-90059
Medical Research: What are the main findings of the study?Dr. Sinha: Our main finding is that compared to Whites, African Americans (AAs) and Hispanics, with diabetes, have a higher prevalence of early chronic kidney disease (CKD) which is significantly associated with urinary albumin excretion (UAE) and/or C-reactive protein (CRP).
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MedicalResearch.com Interview with: Mark A. Espeland PhD Professor
Department of Biostatistics
Sticht Center on Aging Center for Diabetes Research
WFU Primate Center Center for Integrative Medicine
Translational Science Institute
Wake Forest School of Medicine, Winston-Salem, NC
Medical Research: What are the main findings of the study?Dr. Espeland : Over 10 years, overweight and obese adults with type 2 diabetes who were provided a lifestyle intervention targeting sustained weight loss and increased physical activity, lowered their rates of hospitalizations and medication use and reduced the costs of their health care by over $5,000.
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MedicalResearch.com Interview with: Prof. Chia-Huang Kao
From the Graduate Institute of Clinical Medical Science
Department of Radiation Oncology and Nuclear Medicine and PET Center
Graduate Institute of Clinical Medical Science
China Medical University Hospital, Taichung, Taiwan.
Medical Research: What are the main findings of the study?Prof. Kao: Patients with chronic kidney disease (CKD) are at high risk for hypoglycemia; several factors are reported to contribute to hypoglycemia in these patients. However, most previous studies were limited by the relatively small number of patients with CKD included in the study by the exclusion of cases with CKD. In the present study, the incidence rate of hypoglycemia in patients with CKD was 4.5%, which is approximately twice the value noted in previous reports and multivariate analysis revealed a 2.53-fold increase in the risk of death for CKD patients with hypoglycemia after adjusting for related confounding factors including hypertension, hyperlipidemia, diabetes, and antidiabetic drugs.
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MedicalResearch.com Interview with Karen Margolis, M.D., M.P.H.
Senior Investigator (Director of Clinical Research)
HealthPartners Institute for Education and Research
Minneapolis, MN, 55440-1524
Medical Research: What are the main findings of the study?Dr. Margolis: The study compared falls and fractures in patients aged 40-79 with diabetes who were treated for high blood pressure. One group received treatment that aimed at getting systolic blood pressure under 120, while the other group received treatment to achieve systolic blood pressure under 140. The results show that patients who received intensive blood pressure treatment did not fall more than less intensively treated patients, nor did they incur more fractures over an average follow-up of about five years.
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MedicalResearch.com Interview with: Rohit Varma, MD, MPH
Grace and Emery Beardsley Professor and Chair
USC Department of Ophthalmology
Director, USC Eye Institute
Associate Dean for Strategic Planning and Network Development
Keck School of Medicine of USC
Medical Research: What are the main findings of the study?Dr. Varma: Our research demonstrates African-Americans bear a heavier burden of diabetic macular edema (DME), one of the leading causes of blindness in diabetic patients in the United States, compared to Non-Hispanic whites. The study points to a need for improved screening and greater attention to vision loss by clinicians and patients particularly those who are at high risk of developing diabetic macular edema.
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MedicalResearch.com Interview with: Prof. Michael d’Emden
Endocrine Research Unit
Royal Brisbane Hospital, Brisbane, Australia
Medical Research: What are the main findings of the study?Prof. d’Emden: Our study is the largest trial of women having type 2 diabetes assessing the role of a fibric acid derivative, in this case fenofibrate, ever conducted. There were 3657 female subjects randomized to placebo or fenofibrate. The study demonstrated greater reductions in women of total cholesterol, triglycerides and LDL-cholesterol and greater increases in HDL-cholesterol. In women, fenofibrate decreased total cardiovascular end-points by 30% compared with only 13% in men, although there was no-treatment-by-sex interaction. The majority of end points assessed revealed a consistent trend to increased benefit being seen in women.
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MedicalResearch.com Interview with: Kristian Karstoft MD
The Centre of Inflammation and Metabolism and The Centre for Physical Activity ResearchDepartment of Infectious Diseases and CMRC, Rigshospitalet
Faculty of Health Sciences,
University of Copenhagen, Copenhagen, Denmark
Medical Research: What are the main findings of the study?Dr. Karstoft:Four months of Interval-walking training (IWT; five sessions/week, one hour/session) in individuals with type 2 diabetes mellitus maintained insulin secretion, improved insulin sensitivity index and disposition index in opposition to energy-expenditure and time-duration matched continuous walking training (CWT).
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MedicalResearch.com Interview with: Effie Viguiliouk
M.Sc. Candidate, Department of Nutritional Sciences
University of Toronto
Medical Research: What are the main findings of the study?Effie Viguiliouk: This systematic review and meta-analysis of the totality of evidence from 12 randomized clinical trials in 450 participants with type 2 diabetes found that eating about 1/2 a cup of tree nuts per day (equivalent to about 60 g or 2 servings) significantly lowered the two key markers of blood sugar, HbA1c and fasting glucose, in comparison to calorically matched control diets without tree nuts.
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MedicalResearch.com Interview with: Petter Bjornstad, M.D.
Children's Hospital Colorado
University of Colorado Denver
Aurora, CO 80045
Medical Research: What are the main findings of the study?Dr. Bjornstad: Type 2 diabetes is the most common cause of end-stage renal disease in the Western world. It is therefore of paramount importance to develop a better understanding of the determinants of diabetic nephropathy risk and progression, to improve outcome in adolescents with type 2 diabetes.
We report high rates of microalbuminuria and renal hyperfiltration in adolescents with type 2 diabetes, which forecast early renal morbidity and mortality. In our observational study, insulin sensitivity measured by hyperinsulinemic-euglycemic clamp studies, rather than adiposity, blood pressure, lipid and glycemic control was associated with markers of renal health (albumin-to-creatinine ratio and estimated glomerular filtration rate).
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MedicalResearch.com Interview with: Grant Brinkworth PhD
Associate Professor
Senior Research Scientist
CSIRO Animal, Food and Health Sciences
Adelaide BC, South Australia
Medical Research: What are the main findings of the study?Dr. Brinkworth: Both a very low carbohydrate, high protein, high unsaturated fat diet and a high carbohydrate, low fat diet achieved similar weight loss, improvements in body composition and health risk markers. However, compared to the high carbohydrate, low fat diet, a very low carbohydrate high protein, high unsaturated fat diet had more favourable effects on blood lipid profile, glycemic control (indicated by greater reductions in glycosylated haemoglobin – primary clinical measure of blood glucose control and the requirements for blood glucose controlling drugs) and for reducing daily blood glucose fluctuations.
The findings from this study suggests that a novel eating pattern that markedly limits carbohydrates, increases protein and unsaturated fat may have more favourable therapeutic potential for optimising the management of type 2 diabetes and reducing cardiovascular disease risk.
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MedicalResearch.com Interview with:Yung-Song Lin MD
Chi Mei Medical Center
Taipei Medical University
Medical Research: What are the main findings of the study?Dr. Lin: The risks of developing oral cavity cancer, oropharyngeal cancer, and nasopharyngeal cancer (NPC) were significantly higher in patients with diabetes.
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MedicalResearch.com Interview with: Professor Zuxun Lu
School of Public Health
Tongii Medical College
Huazhong University of Science and Technology
Wuhun, Hubei, China.
Medical Research: What are the main findings of the study?Prof. Lu: The main finding of this systematic review and meta-analysis was that shift work is associated with an increased risk of diabetes mellitus (DM). The association between shift work and DM appeared to be independent of physical activity, family of history of DM and body mass index. We found that the increased risk of diabetes mellitus was more pronounced in rotating shift group and male shift workers than in other shift group and female shift workers, respectively.
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MedicalResearch.com Interview with: Qiuyin Cai, M.D., Ph.D.
Associate Professor of Medicine
Vanderbilt University
Medical Research: What are the main findings of the study?Dr. Cai: We conducted a genome-wide association study in East Asians to search for additional genetic changes that are linked to breast cancer development. The study was conducted as part of the Asia Breast Cancer Consortium, which includes 22,780 women with breast cancer and 24,181 control subjects. We found DNA sequence changes in two genes, PRC1 and ZC3H11A, and a change near the ARRDC3 gene were associated with breast cancer risk. These results were also replicated in a large consortium, including 16,003 breast cancer cases and 41,335 control subjects of European ancestry.
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MedicalResearch.com Interview with: Dr Alex Dregan
Lecturer in Translational Epidemiology and Public Health,
Division of Primary Care and Public Health Research
King's College London, London
Medical Research: What are the main findings of the study?
Dr. Dregan: Our study showed that chronic inflammation was associated with increased risk of developing cardiovascular disease, specifically type II diabetes and coronary heart disease. The risk of cardiovascular disease increased with the severity of inflammatory disorders. In addition, inflammation also increased the risk of multiple morbidity (two or more cardiovascular diseases).
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MedicalResearch.com Interview with:Eric Ravussin, Ph.D., Boyd Professor
Director Nutrition Obesity Research Center
Douglas L. Gordon Chair in Diabetes and Metabolism
Associate Executive Director for Clinical Science
Baton Rouge LA
Medical Research: What is the background of this study?Dr. Ravussin: It has long been postulated that hypoxia is bad for metabolic health.
Hypoxia of adipose tissue has been thought to cause oxidative stress, resulting in the recruitment of macrophages with resultant secretion of cytokines and inflammation. However, repeated bouts of hypoxia induced during vigorous exercise results in increased glucose uptake and vascularization of muscle tissue. In addition, living at high altitude is associated with a lower prevalence of impaired fasting glucose and type 2 diabetes compared with living at low altitude.
Therefore, we asked the question, “What is the balance between the beneficial effects of hypoxia in muscle tissue and ‘bad’ effects in adipose tissue”? We devised a study in eight healthy men of different ethnicities, put into a hypoxic environment for 10 consecutive nights for 10 hours. The subjects slept in a hypoxic tent, using nitrogen dilution.
Medical Research: What are the main findings of the study?Dr. Ravussin: The main findings of this study included:
Adipose tissue hypoxia was confirmed;
Subjects lost an average of 1.2 kg;
This study reports for the first time a reduced fasting glucose level and improved whole-body (skeletal muscle) and hepatic insulin sensitivity after nightly exposure to moderate hypoxia.
MedicalResearch.com Interview with: Professor Daniela Jakubowicz MD
Diabetes Unit. E. Wolfson Medical Center
Sackler Faculty of Medicine,
Tel Aviv University
and Tel Aviv Medical Center, Israel
Medical Research: What are the main findings of the study?Prof. Jakubowicz: In type 2 diabetes there is a deficit of post-meal insulin secretion (from pancreatic beta-cells) that contributes to an exaggerated elevation in blood glucose. In this study we found that consumption of whey protein shortly before breakfast augmented GLP-1 (a gut hormone that stimulates insulin secretion) enhancing insulin response and lowering glucose excursions after breakfast.
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MedicalResearch.com Interview with:
Vincenza Spallone MD PhD
Endocrinology and Neurology
Department of Systems Medicine
Tor Vergata University, Rome, Italy
Medical Research: What are the main findings of the study?Dr. Spallone:To investigate a possible relationship between painful diabetic polyneuropathy (PDPN) and the circadian pattern of blood pressure (BP), we performed ambulatory blood pressure monitoring in 113 diabetic patients with PDPN, with painless diabetic polyneuropathy (DPN) and without DPN. In addition, we evaluated neuropathic pain, sleep, risk for obstructive sleep apnoea (OSA), autonomic function, and in a subgroup of patients, depressive symptoms.
The main finding was that patients with painful diabetic polyneuropathy displayed impaired nocturnal fall in BP compared to those without neuropathy, and higher nocturnal systolic blood pressure than the other two groups. Although the day-night change (∆) in blood pressure failed to reach a significant difference between painful diabetic polyneuropathy and DPN groups, nondipping (the loss of nocturnal fall in systolic BP) was more strictly associated with painful diabetic polyneuropathy than DPN and in multivariate analysis, including comorbidities and most potential confounders, neuropathic pain was an independent determinant of ∆ BP and nocturnal systolic blood pressure.
In summary, we showed a novel association of peripheral diabetic neuropathic pain with nondipping and higher systolic nocturnal blood pressure, which was not entirely explained through pain dependent sleep problems or other pain- or diabetes-related comorbidities, like CAN, OSA and depression.
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MedicalResearch.com: Interview with: Interview with Professor Donald W Bowden and Dr. Amanda J Cox
Center for Diabetes Research,
Center for Genomics and Personalized Medicine Research
Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC
Medical Research: What are the main findings of the study?Answer: The study examined modifiable cardiovascular disease (CVD) risk factors and risk for mortality in a subset of individuals from the Diabetes Heart Study who were at high risk based for cardiovascular disease based on burden of subclinical CVD assessed by coronary artery calcified plaque scores greater than 1000. Even among this high risk group, known CVD risk factors were still useful in assessing ongoing risk for mortality. Use of cholesterol-lowering medication was one factor identified to be protective against mortality.
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MedicalResearch.com: Interview with: Lukas Schwingshackl, MSc
Department of Nutritional Sciences
University of Vienna
Vienna, AUSTRIA
Medical Research: What are the main findings of the study?Lukas Schwingshackl: The results of the present meta-analyses showed that, in patients with established diabetes, aerobic training might be more effective in reducing glycosylated haemoglobin and fasting glucose when compared with resistance training. Combined aerobic and resistance training was more powerful in reducing glycosylated haemoglobin compared with aerobic training, and more effective in reducing glycosylated haemoglobin, fasting glucose and tricylglycerols when compared with resistance training. However, these results could not be confirmed when only low risk of bias studies were included.
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MedicalResearch.com Interview with: Professor Yves Reznik
Department of Endocrinology,
University of Caen Côte de Nacre Regional Hospital Center
Caen, FranceMedicalResearch: What are the main findings of the study?Prof. Reznik: OPT2MISE definitively demonstrate that pump therapy is a valuable option for treating those type 2 diabetes patients with uncontrolled hyperglycemia despite a high dose insulin regimen including at least 3 injections per day of rapid-acting and slow-acting insulin analogues, the gold standard for intensified insulin therapy. Such benefit on glucose control is obtained with lower daily insulin doses and without weight gain in comparison with multiple injection therapy. Pump therapy is effective in a population of patients un-preselected for their ability to deal with a medical device.
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MedicalResearch.com Interview with:Yalcin Basaran, MD
Gulhane Military Medical Academy School of Medicine
Ankara, Turkey.
MedicalResearch: What are the main findings of the study?Dr. Basaran: We designed a cross-sectional study to identify the relation between the gut microbiota composition and obesity and diabetes. 27 severely obese individuals (20 men and 7 women with mean BMI: 39.98±5.56 kg/m2), 26 patients with newly diagnosed type 2 diabetes (18 men and 8 women with mean BMI: 28.63±5.08 kg/m2) and 28 healthy control subjects (22 men and 6 women with mean BMI: 23.02±1.70 kg/m2), between 18-65 years of age, were included in the present study. None of the participants was undergoing chronic treatment and no antibiotics, probiotics or prebiotics were taken within 3 months before collecting fecal material. Fecal samples were self-collected in sterile boxes, stored at -80o until analysis, and analyzed by quantitative real-time PCR for the presence of the most common types of intestinal bacteria.
Although tended to increase, we observed no significant difference between the three groups in regards to fecal concentrations of Bacteroidetes. There was also no considerable difference in the fecal Bifidobacteria, Firmicutes and Clostridium Leptum levels among the obesity and diabetes groups. However, Bifidobacteria, Firmicutes and Clostridium Leptum counts were all significantly lower in obese and diabetic patients compared with healthy control individuals. Additionally, logistic regression analysis showed that parameters of adiposity (weight, BMI and waist circumference) and those of glucose control (FBG and HbA1c) were related to the altered gut microbiota composition. This suggests that alterations in the gut microbiota composition may influence metabolic profile in humans. (more…)
MedicalResearch.com Interview with:Sandeep Vijan, MD, MS
Center for Clinical Management Research
Ann Arbor Veterans Affairs Hospital,
Department of Internal Medicine, University of Michigan,
Ann Arbor MichiganMedicalResearch: What are the main findings of the study?Dr. Vijan:The main finding was that the burdens and side effects of intensive glycemic treatment significantly detract from the overall benefit of lower risks of diabetes complications, often to the point where the treatments cause more loss than gain in quality of life. It takes many (often 15-20) years to gain benefit from treatment, but the burdens begin right away and continue throughout treatment. By the time you might experience treatment benefit in terms of reduced complication risk, you've had a lot of years to have the downsides of treatment - which commonly include significant weight gain, low blood sugars, gastrointestinal symptoms, not to mention having to take multiple pills or injections on a daily basis.
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MedicalResearch.com: Interview with Dr. Domenico Accili MD
Professor of Medicine
Department of Medicine
Columbia University College of Physicians and Surgeons
New York, New York 10032
MedicalResearch: What are the main findings of the study?Dr. Accili: By switching off a single gene (foxo1), scientists at Columbia University’s Naomi Berrie Diabetes Center have converted human gastrointestinal cells into insulin-producing cells, demonstrating in principle that a drug could retrain cells inside a person’s GI tract to produce insulin.
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MedicalResearch.com Interview with: Su Ann Ding, MBBS
Research Fellow
Joslin Diabetes Center
Boston, Massachusetts
MedicalResearch: What are the main findings of the study?Answer:We conducted a randomized controlled trial comparing the effectiveness of Roux-en- Y gastric bypass with an intensive diabetes and weight management program. We recruited 38 obese individuals (BMI 30-42 kg/m2) with type 2 diabetes. Participants had suboptimal glucose control and mean diabetes duration of 10 years.
Both surgical and non-surgical interventions led to patients losing a clinically significant amount of weight and keeping it off for 2 years, with average loss of approximately 57 pounds (25% of initial body weight) for the surgery group and 13 pounds (6% of initial weight) for the lifestyle and medication modification group. Other important health goals also improved more in the surgical group, including improvements in blood sugar control, blood pressure and lipid levels which together may contribute to reducing risk of developing coronary heart disease.
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MedicalResearch.com Interview with: Dr Anju Joham
PhD student, SPHPM
Endocrinologist, Monash Health
MedicalResearch: What is the background for your study?Dr. Joham: This research led by Professor Helena Teede and Dr Anju Joham, from the School of Public Health and Preventive Medicine at Monash University analysed a large-scale epidemiological study, called the Australian Longitudinal Study of Women’s Health (ALSWH).
Polycystic Ovary Syndrome (PCOS) is a condition affecting nearly 20% of Australian women. Women with PCOS may experience irregular menstrual cycles, reduced fertility, increased risk of diabetes, high cholesterol and psychological features such as depression and reduced quality of life.
MedicalResearch: What are the main findings of the study?Dr. Joham: Approximately 6000 women aged between 25-30 years were monitored for nine years, including nearly 500 women with diagnosed PCOS. Our research found that there is a clear link between PCOS and type 2 diabetes. The incidence and prevalence of type 2 diabetes was three to five times higher in women with PCOS. In analysing the key contributing factors to the increased diabetes risk, we found that having PCOS was in itself a key contributing factor.
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MedicalResearch.com Interview with:Athena Philis-Tsimikas, M.D.
Corporate Vice President
Scripps Whittier Diabetes Institute, a subsidiary of Scripps Health
MedicalResearch: What are the main findings of the study?Dr. Philis-Tsimikas: Findings from the Dulce Digital study suggest that a text message-based self-management intervention improves glycemic control in high risk Latinos with type 2 diabetes.
Researchers recruited 126 Latinos with type 2 diabetes and HbA1c greater than 7.5% from federally-qualified health centers (FQHCs) that serve disadvantaged populations to investigate the impact of a diabetes self-management intervention delivered via mobile text messaging. Cell phones were provided to patients who did not have them, along with text messaging instructions.
Patients were randomized after completing clinical and self-reported measurements at baseline and these assessments were then repeated at 3 and 6 months. Both Dulce Digital and control groups received usual care. The Dulce Digital group received three types of text messages — educational and motivational; medication reminders; and blood glucose monitoring prompts — two to three messages each day initially, with frequency tapering over 6 months. Project Dulce staff then monitored blood glucose responses, assessed reasons for hyperglycemia or hypoglycemia and encouraged follow up with providers as needed.
Still ongoing, the current analyses included 106 completed participants (mean age= 49.25±9.49 years, 74% female), 52 of which were Dulce Digital participants. Findings showed significantly greater decreases in HbA1c with text messages compared with usual care only (9.4% to 8.4%, vs. 9.5% to 9.3%, P<.05) at 6 month follow-up. No significant group differences, however, have been observed for lipids, weight or blood pressure.
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