Field Notes

Community Approach Effective in Fight Against Diabetes

New research from Wake Forest Baptist Medical Center shows that a diabetes prevention program led by community health workers is effective at reducing blood glucose and potentially reducing diabetes over the long term.

This is the largest program to successfully replicate the results achieved by the Diabetes Prevention Project, a research study led by the National Institutes of Health and supported by the Centers for Disease Control and Prevention, which demonstrated several years ago that lifestyle weight-loss interventions can reduce the incidence of diabetes by 58%. The study recently was published in the American Journal of Preventive Medicine.

“We wanted to take this intervention out to people in the community rather than having them have to come to us in a clinical setting,” says Jeff Katula, PhD, the study’s lead author who’s an assistant professor of health and exercise sciences at Wake Forest University and joint assistant professor of epidemiology and prevention at Wake Forest Baptist. “Given the high prevalence of obesity and metabolic syndrome and risk of diabetes, our study shows we can provide an effective program in a community setting.”

Because the Diabetes Prevention Project involved substantial amounts of resources and specialized personnel, the goal of the Wake Forest Baptist study was to test a translation of the project’s model in community settings. The lifestyle weight-loss interventions were conducted by community health workers in parks and recreation centers rather than by health care professionals in clinical settings.

The research team examined the effects of a 24-month lifestyle weight-loss program in 301 participants who were overweight or obese and had elevated fasting blood glucose, a common indicator of prediabetes. The study was conducted in and around Forsyth County, North Carolina, from 2007 through 2011, with the volunteers representing the racial composition of the county’s population. Fasting blood glucose, insulin, insulin resistance, body weight, BMI, and waist circumference were assessed every six months for 24 months.

Study volunteers were assigned randomly either to a group-based, lifestyle weight-loss intervention or an enhanced usual care comparison. The comparison was designed to exceed the usual care a person with prediabetes typically would receive, which might include a physician advising a patient to lose weight and exercise. In this study, the enhanced comparison provided for participants two meetings with an RD and monthly newsletters.

Results indicated that the significant reductions in body weight, BMI, waist circumference, fasting blood glucose, insulin, and insulin resistance achieved during the first year of the program by the lifestyle weight-loss group largely were maintained in the second year compared with the usual care group. Additionally, at 24 months, the percentage of volunteers who lost 5% or more of their initial body weight was 46.5% in the lifestyle weight-loss group vs. 15% in the usual care group.

“Many previous studies have shown that people can lose weight for six months, but maintaining those changes, particularly metabolic changes, over time is the real challenge,” Katula says.

The study was limited in that participants were from only one county in North Carolina that included a midsized city. It’s unknown whether this type of intervention can be implemented effectively in varying geographic locations involving various racial distributions and/or in rural settings, Katula says.

— Source: Wake Forest Baptist Medical Center


For Smokers, Low Levels of Vitamin D May Lead to Cancer

New research appearing online in Clinical Chemistry shows that decreased levels of vitamin D may predispose smokers to developing tobacco-related cancer. This study illustrates that simple vitamin D blood tests and supplements have the potential to improve smokers’ health.

In the United States alone, cigarette smoking accounts for more deaths annually than HIV, illegal drugs, alcohol, motor vehicle injuries, suicides, and murders combined. It’s the primary causal factor for at least 30% of all cancer deaths and can lead to multiple kinds of cancer, including bladder, cervical, esophageal, head and neck, kidney, liver, lung, pancreatic, and stomach, as well as myeloid leukemia. According to the Centers for Disease Control and Prevention, the health care expenditures and productivity losses due to smoking cost the economy approximately $193 billion per year.

In this paper, Afzal and colleagues measured plasma vitamin D levels in blood samples collected from 1981 to 1983 from 10,000 Danes from the general population. Researchers then followed the study participants for up to 28 years through the Danish Cancer Registry. Of the participants, 1,081 eventually developed a tobacco-related cancer. The authors determined that the median vitamin D concentration among these participants was only 14.8 ng/mL vs. the higher 16.4 ng/mL median concentration found for all participants together.

These results show for the first time that the risk of tobacco-related cancers as a group is associated with lower concentrations of vitamin D. The data also indicate that tobacco smoke chemicals may influence vitamin D metabolism and function, while vitamin D may conversely modify the carcinogenicity of tobacco smoke chemicals. If further research confirms this, it would be consistent with previous studies demonstrating the antitumorigenic effects of vitamin D derivatives as well as the correlation of vitamin D deficiency with favorable cancer-forming conditions and increased susceptibility to tobacco smoke carcinogens. Interestingly, though, low vitamin D levels weren’t connected with risk of other cancer types.

“Our analyses show that the association between lower concentrations of plasma vitamin D and higher risk of cancer may be driven by tobacco-related cancer as a group, which hasn’t been shown before,” author Børge G. Nordestgaard, MD, DMSc, stated in the paper. “This is important for future studies investigating the association between plasma vitamin D and risk of cancer.”

— Source: American Association for Clinical Chemistry