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Assessment of a Multidisciplinary Intervention in Patients With BMI ≥35 kg/m2 and Recently Diagnosed Type 2 Diabetes.

Identifieur interne : 000073 ( Main/Exploration ); précédent : 000072; suivant : 000074

Assessment of a Multidisciplinary Intervention in Patients With BMI ≥35 kg/m2 and Recently Diagnosed Type 2 Diabetes.

Auteurs : Ana Cristina García-Ulloa [Mexique] ; Victoria Landa-Anell [Mexique] ; Marco Melgarejo-Hernández [Mexique] ; Andrea Villegas-Narvaez [Mexique] ; Luz Elena Urbina-Arronte [Mexique] ; Sergio Hernández-Jiménez [Mexique]

Source :

RBID : pubmed:30912810

Descripteurs français

English descriptors

Abstract

CONTEXT

Patients with a body mass index (BMI) ≥35 kg/m2 have lower benefits with intensive treatments and metabolic control goals are more difficult to reach.

OBJECTIVE

Evaluate the effect of a comprehensive care program in patients with a BMI ≥35 kg/m2.

DESIGN

Prospective cohort study.

SETTING

Comprehensive Care Center in a National Institute of Health.

PATIENTS

Patients with type 2 diabetes, ≤5 years of diagnosis, without disabling complications, nonsmokers, and a BMI <45 kg/m2.

INTERVENTIONS

Exercise and nutritional interventions are modified for patients with a higher BMI to achieve metabolic control.

MAIN OUTCOME MEASURES

Main outcome is achievement of treatment goals defined as HbA1c <7%, low-density lipoprotein cholesterol (LDL-c) <100 mg/dL, and blood pressure <130/80 mm Hg. Secondary measures were the percentage of patients achieving three metabolic goals.

RESULTS

A total of 587 patients with annual evaluation were included. Mean age was 55.3 ± 9.5 years, 56.6% women, time since diagnosis of 1 year (0 to 5). BMI <35 kg/m2 group included 521 patients and BMI ≥35 kg/m2 group included 66 patients. In the BMI ≥35 kg/m2 group, we observed a greater decrease in weight and fat mass at 3 months compared with <35 kg/m2 group, but the HbA1c, LDL-c, or blood pressure goals were similar at 3 months and 1 year between groups.

CONCLUSIONS

Comprehensive interventions are equally effective in patients with recently diagnosed type 2 diabetes with BMI ≥35 kg/m2 compared with patients with a lower BMI.


DOI: 10.1210/jc.2018-01148
PubMed: 30912810


Affiliations:


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Le document en format XML

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<term>Aged (MeSH)</term>
<term>Blood Pressure (MeSH)</term>
<term>Cholesterol, LDL (metabolism)</term>
<term>Cohort Studies (MeSH)</term>
<term>Dentists (MeSH)</term>
<term>Diabetes Mellitus, Type 2 (complications)</term>
<term>Diabetes Mellitus, Type 2 (metabolism)</term>
<term>Diabetes Mellitus, Type 2 (therapy)</term>
<term>Diet Therapy (methods)</term>
<term>Endocrinologists (MeSH)</term>
<term>Exercise Therapy (methods)</term>
<term>Female (MeSH)</term>
<term>Glycated Hemoglobin A (metabolism)</term>
<term>Humans (MeSH)</term>
<term>Life Style (MeSH)</term>
<term>Male (MeSH)</term>
<term>Middle Aged (MeSH)</term>
<term>Nutritionists (MeSH)</term>
<term>Obesity (complications)</term>
<term>Obesity (metabolism)</term>
<term>Obesity (therapy)</term>
<term>Ophthalmologists (MeSH)</term>
<term>Patient Care Team (MeSH)</term>
<term>Patient Education as Topic (methods)</term>
<term>Physical Therapists (MeSH)</term>
<term>Prospective Studies (MeSH)</term>
<term>Psychiatry (MeSH)</term>
<term>Psychology (MeSH)</term>
<term>Social Support (MeSH)</term>
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<term>Adulte d'âge moyen (MeSH)</term>
<term>Cholestérol LDL (métabolisme)</term>
<term>Dentistes (MeSH)</term>
<term>Diabète de type 2 (complications)</term>
<term>Diabète de type 2 (métabolisme)</term>
<term>Diabète de type 2 (thérapie)</term>
<term>Diétothérapie (méthodes)</term>
<term>Endocrinologues (MeSH)</term>
<term>Femelle (MeSH)</term>
<term>Humains (MeSH)</term>
<term>Hémoglobine A glycosylée (métabolisme)</term>
<term>Kinésithérapeutes (MeSH)</term>
<term>Mode de vie (MeSH)</term>
<term>Mâle (MeSH)</term>
<term>Nutritionnistes (MeSH)</term>
<term>Obésité (complications)</term>
<term>Obésité (métabolisme)</term>
<term>Obésité (thérapie)</term>
<term>Ophtalmologistes (MeSH)</term>
<term>Pression sanguine (MeSH)</term>
<term>Psychiatrie (MeSH)</term>
<term>Psychologie (MeSH)</term>
<term>Soutien social (MeSH)</term>
<term>Sujet âgé (MeSH)</term>
<term>Traitement par les exercices physiques (méthodes)</term>
<term>Éducation du patient comme sujet (méthodes)</term>
<term>Équipe soignante (MeSH)</term>
<term>Études de cohortes (MeSH)</term>
<term>Études prospectives (MeSH)</term>
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<term>Cholesterol, LDL</term>
<term>Glycated Hemoglobin A</term>
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<term>Diabetes Mellitus, Type 2</term>
<term>Obesity</term>
</keywords>
<keywords scheme="MESH" qualifier="metabolism" xml:lang="en">
<term>Diabetes Mellitus, Type 2</term>
<term>Obesity</term>
</keywords>
<keywords scheme="MESH" qualifier="methods" xml:lang="en">
<term>Diet Therapy</term>
<term>Exercise Therapy</term>
<term>Patient Education as Topic</term>
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<term>Cholestérol LDL</term>
<term>Diabète de type 2</term>
<term>Hémoglobine A glycosylée</term>
<term>Obésité</term>
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<term>Traitement par les exercices physiques</term>
<term>Éducation du patient comme sujet</term>
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<term>Diabetes Mellitus, Type 2</term>
<term>Obesity</term>
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<term>Diabète de type 2</term>
<term>Obésité</term>
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<keywords scheme="MESH" xml:lang="en">
<term>Aged</term>
<term>Blood Pressure</term>
<term>Cohort Studies</term>
<term>Dentists</term>
<term>Endocrinologists</term>
<term>Female</term>
<term>Humans</term>
<term>Life Style</term>
<term>Male</term>
<term>Middle Aged</term>
<term>Nutritionists</term>
<term>Ophthalmologists</term>
<term>Patient Care Team</term>
<term>Physical Therapists</term>
<term>Prospective Studies</term>
<term>Psychiatry</term>
<term>Psychology</term>
<term>Social Support</term>
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<keywords scheme="MESH" xml:lang="fr">
<term>Adulte d'âge moyen</term>
<term>Dentistes</term>
<term>Endocrinologues</term>
<term>Femelle</term>
<term>Humains</term>
<term>Kinésithérapeutes</term>
<term>Mode de vie</term>
<term>Mâle</term>
<term>Nutritionnistes</term>
<term>Ophtalmologistes</term>
<term>Pression sanguine</term>
<term>Psychiatrie</term>
<term>Psychologie</term>
<term>Soutien social</term>
<term>Sujet âgé</term>
<term>Équipe soignante</term>
<term>Études de cohortes</term>
<term>Études prospectives</term>
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<front>
<div type="abstract" xml:lang="en">
<p>
<b>CONTEXT</b>
</p>
<p>Patients with a body mass index (BMI) ≥35 kg/m2 have lower benefits with intensive treatments and metabolic control goals are more difficult to reach.</p>
</div>
<div type="abstract" xml:lang="en">
<p>
<b>OBJECTIVE</b>
</p>
<p>Evaluate the effect of a comprehensive care program in patients with a BMI ≥35 kg/m2.</p>
</div>
<div type="abstract" xml:lang="en">
<p>
<b>DESIGN</b>
</p>
<p>Prospective cohort study.</p>
</div>
<div type="abstract" xml:lang="en">
<p>
<b>SETTING</b>
</p>
<p>Comprehensive Care Center in a National Institute of Health.</p>
</div>
<div type="abstract" xml:lang="en">
<p>
<b>PATIENTS</b>
</p>
<p>Patients with type 2 diabetes, ≤5 years of diagnosis, without disabling complications, nonsmokers, and a BMI <45 kg/m2.</p>
</div>
<div type="abstract" xml:lang="en">
<p>
<b>INTERVENTIONS</b>
</p>
<p>Exercise and nutritional interventions are modified for patients with a higher BMI to achieve metabolic control.</p>
</div>
<div type="abstract" xml:lang="en">
<p>
<b>MAIN OUTCOME MEASURES</b>
</p>
<p>Main outcome is achievement of treatment goals defined as HbA1c <7%, low-density lipoprotein cholesterol (LDL-c) <100 mg/dL, and blood pressure <130/80 mm Hg. Secondary measures were the percentage of patients achieving three metabolic goals.</p>
</div>
<div type="abstract" xml:lang="en">
<p>
<b>RESULTS</b>
</p>
<p>A total of 587 patients with annual evaluation were included. Mean age was 55.3 ± 9.5 years, 56.6% women, time since diagnosis of 1 year (0 to 5). BMI <35 kg/m2 group included 521 patients and BMI ≥35 kg/m2 group included 66 patients. In the BMI ≥35 kg/m2 group, we observed a greater decrease in weight and fat mass at 3 months compared with <35 kg/m2 group, but the HbA1c, LDL-c, or blood pressure goals were similar at 3 months and 1 year between groups.</p>
</div>
<div type="abstract" xml:lang="en">
<p>
<b>CONCLUSIONS</b>
</p>
<p>Comprehensive interventions are equally effective in patients with recently diagnosed type 2 diabetes with BMI ≥35 kg/m2 compared with patients with a lower BMI.</p>
</div>
</front>
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<Day>01</Day>
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<Issue>7</Issue>
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<Title>The Journal of clinical endocrinology and metabolism</Title>
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<Abstract>
<AbstractText Label="CONTEXT">Patients with a body mass index (BMI) ≥35 kg/m2 have lower benefits with intensive treatments and metabolic control goals are more difficult to reach.</AbstractText>
<AbstractText Label="OBJECTIVE">Evaluate the effect of a comprehensive care program in patients with a BMI ≥35 kg/m2.</AbstractText>
<AbstractText Label="DESIGN">Prospective cohort study.</AbstractText>
<AbstractText Label="SETTING">Comprehensive Care Center in a National Institute of Health.</AbstractText>
<AbstractText Label="PATIENTS">Patients with type 2 diabetes, ≤5 years of diagnosis, without disabling complications, nonsmokers, and a BMI <45 kg/m2.</AbstractText>
<AbstractText Label="INTERVENTIONS">Exercise and nutritional interventions are modified for patients with a higher BMI to achieve metabolic control.</AbstractText>
<AbstractText Label="MAIN OUTCOME MEASURES">Main outcome is achievement of treatment goals defined as HbA1c <7%, low-density lipoprotein cholesterol (LDL-c) <100 mg/dL, and blood pressure <130/80 mm Hg. Secondary measures were the percentage of patients achieving three metabolic goals.</AbstractText>
<AbstractText Label="RESULTS">A total of 587 patients with annual evaluation were included. Mean age was 55.3 ± 9.5 years, 56.6% women, time since diagnosis of 1 year (0 to 5). BMI <35 kg/m2 group included 521 patients and BMI ≥35 kg/m2 group included 66 patients. In the BMI ≥35 kg/m2 group, we observed a greater decrease in weight and fat mass at 3 months compared with <35 kg/m2 group, but the HbA1c, LDL-c, or blood pressure goals were similar at 3 months and 1 year between groups.</AbstractText>
<AbstractText Label="CONCLUSIONS">Comprehensive interventions are equally effective in patients with recently diagnosed type 2 diabetes with BMI ≥35 kg/m2 compared with patients with a lower BMI.</AbstractText>
<CopyrightInformation>Copyright © 2019 Endocrine Society.</CopyrightInformation>
</Abstract>
<AuthorList CompleteYN="Y">
<Author ValidYN="Y">
<LastName>García-Ulloa</LastName>
<ForeName>Ana Cristina</ForeName>
<Initials>AC</Initials>
<AffiliationInfo>
<Affiliation>Centro de Atención Integral del Paciente con Diabetes (CAIPaDi), Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.</Affiliation>
</AffiliationInfo>
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<LastName>Landa-Anell</LastName>
<ForeName>Victoria</ForeName>
<Initials>V</Initials>
<AffiliationInfo>
<Affiliation>Centro de Atención Integral del Paciente con Diabetes (CAIPaDi), Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y">
<LastName>Melgarejo-Hernández</LastName>
<ForeName>Marco</ForeName>
<Initials>M</Initials>
<AffiliationInfo>
<Affiliation>Centro de Atención Integral del Paciente con Diabetes (CAIPaDi), Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.</Affiliation>
</AffiliationInfo>
</Author>
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<LastName>Villegas-Narvaez</LastName>
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<Affiliation>Centro de Atención Integral del Paciente con Diabetes (CAIPaDi), Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y">
<LastName>Urbina-Arronte</LastName>
<ForeName>Luz Elena</ForeName>
<Initials>LE</Initials>
<AffiliationInfo>
<Affiliation>Centro de Atención Integral del Paciente con Diabetes (CAIPaDi), Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y">
<LastName>Hernández-Jiménez</LastName>
<ForeName>Sergio</ForeName>
<Initials>S</Initials>
<AffiliationInfo>
<Affiliation>Centro de Atención Integral del Paciente con Diabetes (CAIPaDi), Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.</Affiliation>
</AffiliationInfo>
</Author>
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<CollectiveName>CAIPaDi Study Group</CollectiveName>
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<Country>United States</Country>
<MedlineTA>J Clin Endocrinol Metab</MedlineTA>
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<NameOfSubstance UI="D008078">Cholesterol, LDL</NameOfSubstance>
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<NameOfSubstance UI="D006442">Glycated Hemoglobin A</NameOfSubstance>
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<NameOfSubstance UI="C517652">hemoglobin A1c protein, human</NameOfSubstance>
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<CitationSubset>AIM</CitationSubset>
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<QualifierName UI="Q000378" MajorTopicYN="N">metabolism</QualifierName>
</MeshHeading>
<MeshHeading>
<DescriptorName UI="D015331" MajorTopicYN="N">Cohort Studies</DescriptorName>
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<MeshHeading>
<DescriptorName UI="D003815" MajorTopicYN="N">Dentists</DescriptorName>
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<MeshHeading>
<DescriptorName UI="D003924" MajorTopicYN="N">Diabetes Mellitus, Type 2</DescriptorName>
<QualifierName UI="Q000150" MajorTopicYN="N">complications</QualifierName>
<QualifierName UI="Q000378" MajorTopicYN="N">metabolism</QualifierName>
<QualifierName UI="Q000628" MajorTopicYN="Y">therapy</QualifierName>
</MeshHeading>
<MeshHeading>
<DescriptorName UI="D004035" MajorTopicYN="N">Diet Therapy</DescriptorName>
<QualifierName UI="Q000379" MajorTopicYN="Y">methods</QualifierName>
</MeshHeading>
<MeshHeading>
<DescriptorName UI="D000072097" MajorTopicYN="N">Endocrinologists</DescriptorName>
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<DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName>
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<MeshHeading>
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<MeshHeading>
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<MeshHeading>
<DescriptorName UI="D008019" MajorTopicYN="N">Life Style</DescriptorName>
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<DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName>
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<MeshHeading>
<DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName>
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<MeshHeading>
<DescriptorName UI="D064686" MajorTopicYN="N">Nutritionists</DescriptorName>
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<MeshHeading>
<DescriptorName UI="D009765" MajorTopicYN="N">Obesity</DescriptorName>
<QualifierName UI="Q000150" MajorTopicYN="N">complications</QualifierName>
<QualifierName UI="Q000378" MajorTopicYN="N">metabolism</QualifierName>
<QualifierName UI="Q000628" MajorTopicYN="Y">therapy</QualifierName>
</MeshHeading>
<MeshHeading>
<DescriptorName UI="D000072163" MajorTopicYN="N">Ophthalmologists</DescriptorName>
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<MeshHeading>
<DescriptorName UI="D010353" MajorTopicYN="N">Patient Education as Topic</DescriptorName>
<QualifierName UI="Q000379" MajorTopicYN="N">methods</QualifierName>
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<MeshHeading>
<DescriptorName UI="D059825" MajorTopicYN="N">Physical Therapists</DescriptorName>
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<MeshHeading>
<DescriptorName UI="D011446" MajorTopicYN="N">Prospective Studies</DescriptorName>
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<MeshHeading>
<DescriptorName UI="D011570" MajorTopicYN="N">Psychiatry</DescriptorName>
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<MeshHeading>
<DescriptorName UI="D011584" MajorTopicYN="N">Psychology</DescriptorName>
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<MeshHeading>
<DescriptorName UI="D012944" MajorTopicYN="N">Social Support</DescriptorName>
</MeshHeading>
</MeshHeadingList>
</MedlineCitation>
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<History>
<PubMedPubDate PubStatus="received">
<Year>2018</Year>
<Month>05</Month>
<Day>25</Day>
</PubMedPubDate>
<PubMedPubDate PubStatus="accepted">
<Year>2019</Year>
<Month>03</Month>
<Day>20</Day>
</PubMedPubDate>
<PubMedPubDate PubStatus="pubmed">
<Year>2019</Year>
<Month>3</Month>
<Day>27</Day>
<Hour>6</Hour>
<Minute>0</Minute>
</PubMedPubDate>
<PubMedPubDate PubStatus="medline">
<Year>2020</Year>
<Month>6</Month>
<Day>2</Day>
<Hour>6</Hour>
<Minute>0</Minute>
</PubMedPubDate>
<PubMedPubDate PubStatus="entrez">
<Year>2019</Year>
<Month>3</Month>
<Day>27</Day>
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<ArticleIdList>
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<affiliations>
<list>
<country>
<li>Mexique</li>
</country>
</list>
<tree>
<country name="Mexique">
<noRegion>
<name sortKey="Garcia Ulloa, Ana Cristina" sort="Garcia Ulloa, Ana Cristina" uniqKey="Garcia Ulloa A" first="Ana Cristina" last="García-Ulloa">Ana Cristina García-Ulloa</name>
</noRegion>
<name sortKey="Hernandez Jimenez, Sergio" sort="Hernandez Jimenez, Sergio" uniqKey="Hernandez Jimenez S" first="Sergio" last="Hernández-Jiménez">Sergio Hernández-Jiménez</name>
<name sortKey="Landa Anell, Victoria" sort="Landa Anell, Victoria" uniqKey="Landa Anell V" first="Victoria" last="Landa-Anell">Victoria Landa-Anell</name>
<name sortKey="Melgarejo Hernandez, Marco" sort="Melgarejo Hernandez, Marco" uniqKey="Melgarejo Hernandez M" first="Marco" last="Melgarejo-Hernández">Marco Melgarejo-Hernández</name>
<name sortKey="Urbina Arronte, Luz Elena" sort="Urbina Arronte, Luz Elena" uniqKey="Urbina Arronte L" first="Luz Elena" last="Urbina-Arronte">Luz Elena Urbina-Arronte</name>
<name sortKey="Villegas Narvaez, Andrea" sort="Villegas Narvaez, Andrea" uniqKey="Villegas Narvaez A" first="Andrea" last="Villegas-Narvaez">Andrea Villegas-Narvaez</name>
</country>
</tree>
</affiliations>
</record>

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