December 2023 Condition Watch: Diabetes

Pharmacist-Led Intervention Could Improve Type 2 Diabetes Outcomes for Hispanic Patients

Pharmacist-led interventions could help improve some outcomes for Hispanic patients with type 2 diabetes, according to the results of a study published in JAMA Network Open.

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The investigators aimed to determine whether pharmacists could lead an intervention with hemoglobin A1C (HbA1C) to affect systolic blood pressure and diabetes outcomes for the patient population.

As part of the intervention, pharmacists reviewed laboratory results and vital signs, performed medication reconciliation, and personalized interventions to address the adherence barriers and care that fit within the guidelines for each patient.

In the analysis, having 1 or more pharmacist visits was associated with a reduction in HbA1C concentration, but there were no changes in systolic blood pressure. A language preference analysis showed a negative association, indicating that HbA1C was reduced when the pharmacist-led intervention was implemented among the subgroup who preferred English language, but there was no significant trend among those with a non-English language preference. There was also no language association with systolic blood pressure, according to the study authors.

Furthermore, there were no significant associations between the HbA1C concentration and pharmacist intervention among those with more than the median number of visits and total contacts, because there was no association for systolic blood pressure.

Study Results Find Decreased Risk of Cardiovascular Disease Post Bariatric Surgery

New study results concluded that obesity-induced inflammation causes a harmful low-density lipoprotein (LDL) interaction that can lead to a higher risk of cardiovascular disease (CVD). However, bariatric surgery could alleviate this concern. LDL functionality is based on nonatherogenic lipoprotein uptake from peripheral cells through an LDL receptor compared with a proatherogenic uptake from arterial macrophages through scavenger receptors.

In the study, blood samples were taken from participants a week before bariatric surgery and 6 to 12 months after. LDL was separated from the plasma, and the plasma was frozen until use. The researchers used findings from previous studies to conclude that LDL functionality was directly linked with the risk of developing CVD. However, the press release noted that even though results from the previous studies did not find a connection between obesity and elevated LDL levels, LDL relates to the content of lipids and proteins that are found in obesity.

Results from the current study found that as the functional changes in LDL made proteins and lipids more proatherogenic, it contributed to obesity- induced inflammation that was reported to decrease in the following year after bariatric surgery.

Time-Restricted Eating May Be Effective for Weight Loss in Patients With T2D

Time-restricted eating (TRE) without calorie counting led to significant weight loss compared with calorie restriction (CR) in patients with type 2 diabetes (T2D), according to findings in JAMA Network Open.

However, both strategies led to a reduction in waist circumference compared with controls by the end of the intervention. Investigators enrolled 75 patients aged 18 to 80 years with obesity and T2D in a 6-month, randomized clinical trial to compare the effects of TRE without calorie counting and CR with a control group on weight reduction and glycemic control. The TRE arm was tasked with eating during the window of 12:00 PM and 8:00 PM (8 hours). The CR arm was assigned to consume 25% fewer calories daily.

Although the TRE intervention did not involve calorie counting, patients still achieved greater energy restriction than patients in the CR arm. Furthermore, the TRE arm reported an easier time adhering to this dieting strategy compared with the CR arm, which is generally one of the main concerns with CR.

The TRE and CR arms both decreased hemoglobin A1C level relative to the control arm. Participants in both interventions experienced reduced waist circumference. The metabolic risk factors evaluated during the study included time in euglycemic range, medication effect score, blood pressure, and plasma lipid. However, the results showed that TRE was not significantly more effective for these outcomes compared with CR.