Summary statement IV: Obesity and diabetes: Opportunities for translation of basic research
ABSTRACT The worldwide epidemics of obesity and diabetes that have emerged in the 21st century are creating a major public heath problem, having struck developed countries as well as those still developing. With our present clinical tools, abilities, and understanding, we may not be prepared to respond adequately to the demands or be able to engage in effective prevention strategies. The underlying pathophysiological reasons for the increases in both obesity and diabetes may be closely related through abnormality in endothelial cells. Diverse expertise from within and outside the public health arena will be needed to explore the health implications from an "endothelium" perspective and identify those at risk for the development of chronic disease. Identification of new biological markers and better measures of current biological marker will both be critical in understanding and addressing the ongoing epidemic of chronic diseases.
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ABSTRACT: Although the Diabetes Prevention Program (DPP) developed a lifestyle weight loss intervention that has been demonstrated to prevent type 2 diabetes in high-risk individuals, it has yet to be widely adopted at the community level. The Healthy Living Partnership to Prevent Diabetes study (HELP PD) was designed to translate the DPP approach for use in community settings as a cost-effective intervention led by Community Health Workers (CHW's) and administered through a Diabetes Care Center (DCC). Approximately 300 overweight and obese (BMI 25-40 kg/m(2)) individuals with prediabetes (fasting blood glucose 95-124 mg/dl) were randomly assigned to either a lifestyle weight loss intervention (LW) or an enhanced usual care comparison condition (UC). The goal of LW is >or=7% weight loss achieved through increases in physical activity (180 min/wk) and decreases in caloric intake (approximately 1500 kcal/day). The intervention consists of CHW-led group-mediated cognitive behavioral meetings that occur weekly for 6 months and monthly thereafter for 18 months. UC consists of 2 individual meetings with a registered dietitian and a monthly newsletter. The primary outcome is change in fasting blood glucose. Secondary outcomes include cardiovascular risk factors, health-related quality of life, and social cognitive variables. Outcomes are masked and are collected every 6 months. The cost-effectiveness of the program will also be assessed. A community-based program that is administered through local DCC's and that harnesses the experience of community members (CHW's) may be a promising strategy for the widespread dissemination of interventions effective at preventing type 2 diabetes in high risk individuals.Contemporary clinical trials 09/2009; 31(1):71-81. DOI:10.1016/j.cct.2009.09.002 · 1.99 Impact Factor
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ABSTRACT: Advancing age is associated with reduced levels of physical activity, increased body weight and fat, decreased lean body mass, and a high prevalence of type 2 diabetes (T2D). Resistance training (RT) increases muscle strength and lean body mass, and reduces risk of T2D among older adults. The Resist Diabetes trial will determine if a social cognitive theory (SCT)-based intervention improves RT maintenance in older, prediabetic adults, using a hybrid efficacy/effectiveness approach. Sedentary, overweight/obese (BMI 25-39.9kg/m(2)) adults aged 50-69 (N=170) with prediabetes (impaired fasting glucose and/or impaired glucose tolerance) completed a supervised 3-month RT (2x/wk) Initiation Phase and were then randomly assigned (n=159; 94% retention) to one of two 6-month maintenance conditions: SCT or Standard care. The SCT intervention consisted of faded contacts compared to Standard care. Participants continue RT at an approved, self-selected community facility during maintenance. A subsequent 6-month period involves no contact for both conditions. Assessments occur at baseline and months 3 (post-initiation), 9 (post-intervention), and 15 (six months after no contact). Primary outcomes are prediabetes indices (i.e., impaired fasting and 2-hour glucose concentration) and strength. Secondary measures include insulin sensitivity, beta-cell responsiveness, and disposition index (oral glucose and C-peptide minimal model); adherence; body composition; and SCT measures. Resist Diabetes is the first trial to examine the effectiveness of a high fidelity SCT-based intervention for maintaining RT in older adults with prediabetes to improve glucose homeostasis. Successful application of SCT constructs for RT maintenance may support translation of our RT program for diabetes prevention into community settings.Contemporary clinical trials 11/2013; 37(1). DOI:10.1016/j.cct.2013.11.006 · 1.99 Impact Factor
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ABSTRACT: The gap in the translation of scientific advances from the laboratory to clinical practice is wide and remains an important challenge (Contopoulos-Ioannidis et al., 2003 and Crowley, 2003), as noted by former National Heart, Lung, and Blood Institute Director Claude Lenfant during the 113th Shattuck Lecture (Lenfant, 2003). An even greater challenge is the translation of these advances into public health practice for health promotion and the prevention of diseases and their risk factors. The 8th International Conference on the Vascular Endothelium brought together clinicians, basic scientists, and for the first time in this series of conferences, public health officials to begin to address these challenges. This multidisciplinary group discussed recent advances in endothelial cell biology, then generated ideas on how best to apply these advances to public health practice, with special emphasis on health promotion and chronic disease prevention. Discussions at the conference form the basis for this supplement. Part I of this editorial reviews the advances in endothelial cell biology presented at the conference (Catravas, in press), and part II explores the scientific basis for health promotion and chronic disease prevention, as well as the relationships between normal endothelial cell biology and core public health interventions to prevent chronic diseases (Mensah, 2007-this issue). A series of six summary statements for advancing the translation of the science into public health practice follows, with focuses on prevention, different chronic diseases, and research directions for the future (Engelgau et al., 2007-this issue, Hooper et al., 2007-this issue-a, Hooper et al., 2007-this issue-b, Mensah et al., 2007-this issue-a, Mensah et al., 2007-this issue-b and Reed et al., 2007-this issue). Strategies and approaches within these summary statements reflect the views of the authors and the conference participants and should not be construed as representing an official position of their affiliated institutions or agencies. Participants at the 8th International Conference on the Vascular Endothelium acknowledged that translating scientific advances into clinical and public health practice, while a priority, is much easier said than done. Yet increased collaborations between vascular biology centers and the public health community must be encouraged and nurtured as a first step toward this ideal. Although these collaborations began at the conference, our challenge now is to keep the enthusiasm and commitments alive to eliminate translational gaps and to reap maximal returns on investments made in basic biomedical research on the vascular endothelium.Vascular Pharmacology 05/2007; .(5). DOI:10.1016/j.vph.2006.10.012 · 4.62 Impact Factor