Rationale: The number of obese older adults with diabetes type 2 is increasing worldwide. Weight loss treatment in this group seems beneficial for cardio-metabolic and other health outcomes, but it might reduce muscle mass and bone mineral density (BMD). The association between obesity and BMD is controversial, and the role of muscle mass and dietary protein intake is not fully clear. This study explores the association between body weight, muscle mass, dietary protein intake, and physical activity level on BMD in obese older adults with diabetes type 2. Methods: For this cross-sectional analysis we used baseline data of a 13-week randomized trial evaluating the effect of a multi-modal intervention on muscle preservation and insulin sensitivity during a weight loss program in obese older adults (55-80y) with diabetes type 2 (PROBE). Body weight was measured using a calibrated scale (Life Measurement), appendicular lean mass (ALM) was used as a proxy for muscle mass and was measured by dual-energy X-ray absorptiometry (DXA, Hologic Discovery A), dietary protein intake was estimated by a 3-day food record, Physical Activity Level (PAL) was estimated by a 3-day activity record, and hip BMD was assessed by DXA. After determination of Pearson’s correlation coefficients for body weight, ALM, protein intake, and PAL with BMD, linear regression analysis was performed with significantly correlating determinants (body weight [kg], ALM [kg], protein intake [g/kg/d], and/or PAL [-]) and hip BMD (g/cm2) as outcome variable. Results: Mean age of the 122 included subjects was 67±6y, with a BMI of 33±4kg/m2. 65% of subjects were male. Body weight and ALM correlated significantly with BMD (r=0.34, p<0.001; r=0.43, p<0.001) whereas protein intake and PAL did not (r=0.02, p=0.84; r=0.005, p=0.95). Linear regression analysis with the two determinants body weight and ALM identified ALM as being significantly associated with BMD, whereas body weight was not. Beta for ALM was +0.011 g/cm2 (95% CI: 0.004 – 0.017; p<0.01), meaning that a 1 kg increase in ALM is associated with a +0.011 g/cm2 increase in BMD. Conclusion: In this explorative cross-sectional analysis appendicular muscle mass is positively associated with BMD, rather than body weight, protein intake, and physical activity level.
mHealth 24/7 is een dienst die diabetespatiënten helpt om op eenvoudige wijze toezicht te houden op hun eigen gezondheid. mDiabetes 24/7 is een prototype app binnen de dienst mHealth 24/7. Op dit moment kunnen patiënten met het prototype van de app hun bloedsuikerwaardes, een eetdagboek en de hoeveelheid toegediende insuline bijhouden. mHealth 24/7 heeft de wens geformuleerd om haar informatievoorziening aan diabetespatiënten verder uit te breiden, door gepersonaliseerd inzicht te geven in de oorzaak van stijgingen en dalingen van hun bloedsuikerwaarden. Meer informatie stelt de patiënt in staat om beter gemotiveerde maatregelen te nemen en stimuleert therapietrouw waarmee later complicaties kunnen worden voorkomen. Dit verbetert de kwaliteit van leven en vermindert kosten.In het project is gerealiseerd dat data uit een activity tracker en omgevingstemperatuur ingelezen wordt in de app en wordt geïntegreerd met bestaande data zoals bloedsuikerwaarde. Daarnaast kunnen patiënten handmatig aangeven hoe ze zich voelen. Patiënten krijgen daarmee inzicht in het effect van activiteit, omgevingstemperatuur en stemming op fluctuaties in bloedsuikerwaardes. In een pilot met 25 proefpersonen is de technische werking van de verrijkte app getest evenals de functionaliteit.Er is aangetoond dat de app werkt en dat voor gebruikers de verrijking van de informatie in de app met hartslag, omgevingstemperatuur en stemming van toegevoegde waarde is. Wel blijkt dat een app zoals deze foutloos en realtime moet werken en de gebruiksinterface dusdanig moet werken, dat de gebruikers er uitsluitend gemak van ondervinden. Diabetes is een arbeidsintensieve ziekte en nog meer werk is ongewenst!Als in een volgende pilot meer data kan worden verzameld, kan worden gewerkt aan het voorspellen van fluctuaties in bloedsuikerwaardes waardoor een patiënt ook voortijdig gewaarschuwd kan worden.Vanuit verschillende marktpartijen zoals ziekenhuizen en zorgverzekeraars is interesse getoond voor het project. Gezamenlijk gaan deze partijen aanspraak doen op tijdelijke financiering vanuit de “Beleidsregel Innovatie Kleinschalige Experimenten.
Background: Chronic low-grade inflammatory profile (CLIP) is one of the pathways involved in type 2 diabetes (T2D). Currently, there is limited evidence for ameliorating effects of combined lifestyle interventions on CLIP in type 2 diabetes. We investigated whether a 13-week combined lifestyle intervention, using hypocaloric diet and resistance exercise plus high-intensity interval training with or without consumption of a protein drink, affected CLIP in older adults with T2D. Methods: In this post-hoc analysis of the PROBE study 114 adults (≥55 years) with obesity and type 2 (pre-)diabetes had measurements of C-reactive protein (CRP), pro-inflammatory cytokines interleukin (IL)-6, tumor-necrosis-factor (TNF)-α, and monocyte chemoattractant protein (MCP)-1, anti-inflammatory cytokines IL-10, IL-1 receptor antagonist (RA), and soluble tumor-necrosis-factor receptor (sTNFR)1, adipokines leptin and adiponectin, and glycation biomarkers carboxymethyl-lysine (CML) and soluble receptor for advanced glycation end products (sRAGE) from fasting blood samples. A linear mixed model was used to evaluate change in inflammatory biomarkers after lifestyle intervention and effect of the protein drink. Linear regression analysis was performed with parameters of body composition (by dual-energy X-ray absorptiometry) and parameters of insulin resistance (by oral glucose tolerance test). Results: There were no significant differences in CLIP responses between the protein and the control groups. For all participants combined, IL-1RA, leptin and adiponectin decreased after 13 weeks (p = 0.002, p < 0.001 and p < 0.001), while ratios TNF-α/IL-10 and TNF-α/IL-1RA increased (p = 0.003 and p = 0.035). CRP increased by 12 % in participants with low to average CLIP (pre 1.91 ± 0.39 mg/L, post 2.13 ± 1.16 mg/L, p = 0.006) and decreased by 36 % in those with high CLIP (pre 5.14 mg/L ± 1.20, post 3.30 ± 2.29 mg/L, p < 0.001). Change in leptin and IL-1RA was positively associated with change in fat mass (β = 0.133, p < 0.001; β = 0.017, p < 0.001) and insulin resistance (β = 0.095, p = 0.024; β = 0.020, p = 0.001). Change in lean mass was not associated with any of the biomarkers. Conclusion: 13 weeks of combined lifestyle intervention, either with or without protein drink, reduced circulating adipokines and anti-inflammatory cytokine IL-1RA, and increased inflammatory ratios TNF-α/IL-10 and TNF-α/IL-1RA in older adults with obesity and T2D. Effect on CLIP was inversely related to baseline inflammatory status.
