This study examined the long-term impact of a 24-month, empowerment-based diabetes self-management support (DSMS) intervention on sustaining health-gains achieved from previous diabetes self-management education (DSME).
This report is based on 60 African-American adults with type 2 diabetes (n=89 recruited at baseline) who completed the study. Prior to the intervention, all participants received 6 months of mailed DSME consisting of weekly educational newsletters coupled with clinical feedback. The intervention consisted of 88 weekly group-based sessions that participants were encouraged to attend as frequently as they needed. Sessions were guided by participants’ self-management questions and also emphasized experiential learning, coping, goal-setting, and problem-solving. Baseline, 6-month, and 30-month assessments measured A1C, weight, body mass index (BMI), blood pressure, lipids, self-care behaviors, and QOL.
Post 6-month DSME, participants demonstrated significant improvements for diastolic BP (p<0.05), serum cholesterol (p<0.001), healthy diet (p<0.01), blood glucose monitoring (p<0.05) and foot exams (p<0.01). Post 24-month intervention, participants sustained the improvements achieved from the 6-month DSME and reported additional improvements for healthy diet (p<0.05), carbohydrate spacing (p<0.01), insulin use, (p<0.05), and quality of life (p<0.05).
Findings suggest that an empowerment-based DSMS model can sustain or improve diabetes-related health gains achieved from previous short-term DSME.
In recognition of the impact of chronic diseases on mental health and the lack of research on Asian American subgroups, the present study examined subjective perceptions of health as a potential mediator in the association between diabetes and depressive symptoms in Korean American older adults.
Multivariate analysis with data from 672 Korean American older adults in Florida explored the mediation model of health perceptions.
The presence of diabetes was associated with negative perceptions of health and elevated symptoms of depression. The proposed mediation model was also supported: negative perceptions of health served as an intervening step between diabetes and depressive symptoms.
The intervening role of health perceptions yields implications for developing health promotion interventions targeting older individuals with diabetes. Results suggest that even in the presence of chronic health conditions, mental well-being of older adults can be maintained by having optimistic beliefs and positive attitudes towards their own health.
Diabetes; Depressive symptoms; Korean American older adults
Novel bone turnover markers could help with the diagnosis and monitoring of osteomyelitis patients. We compared levels of two bone turnover markers, serum amino-terminal telopeptides (NTx) and bone alkaline phosphatase (BAP), in diabetic patients with and without osteomyelitis.
Matched case-control study was conducted with diabetic patients with and without osteomyelitis. Cases not undergoing immediate amputation were followed with repeat measurements after osteomyelitis treatment and for outcome determination.
Analysis included 54 subjects, 27 cases and 27 controls. Median BAP levels were similar between cases and controls at enrollment (p=.55) as were median NTx levels (p=.43). Cases with follow-up data (n = 18) had similar bone marker levels at enrollment and 6 weeks. No significant differences in BAP or NTx levels at enrollment or follow-up were seen between cases with poor versus favorable outcomes.
No differences in NTx or BAP levels were seen between cases and controls. Cases with follow-up data had similar levels at enrollment and 6 weeks. Lack of difference may be due to small sample size, small areas of bone involved in foot osteomyelitis, or limitations of these specific markers. More research is needed.
Osteomyelitis; diabetic foot ulcers; bone markers; treatment outcomes
In patients with diabetes and hypertriglyceridemia, LDL-cholesterol (LDL-C) provides an inaccurate reflection of LDL particle burden. The relative value of non-HDL-cholesterol (non-HDL-C) and apolipoprotein- B (Apo-B) in estimating cardiovascular risk is controversial. We assessed the discordance between non-HDL-C and Apo- B targets in patients with diabetes with TG 200–499 mg/dl.
Data from 1430 determinations of LDL-C, non-HDL-C, and Apo- B in ambulatory patients with diabetes were analyzed. Rates of discordance were calculated, based on the currently recommended LDL-C, non-HDL-C, and Apo-B goals.
In patients with non-HDL-C goal of < 130 mg/dl, there was a discordance with Apo-B level goal of < 90 mg/dl, in 31% of samples. In patients with non-HDL-C goal of < 100 mg/dl, 6 % of samples had Apo-B ≥ 80 and 18% had Apo-B <80 mg/dl. Using the Apo-B goal of < 70mg/dl, these numbers were 37% and 3.5% respectively. There was also a significant gender difference, i.e. under-estimation of risk by suggested non-HDL-C cut-offs, in females, compared to males.
In patients with diabetes and hypertriglyceridemia, a considerable discordance exists between non-HDL-C and Apo-B. Our data suggest a need for prospective studies to compare the relative merits of non-HDL-C and Apo-B targets in the assessment of cardiovascular risk.
Cognitive impairment is common in older adults with diabetes, yet it is unclear to what extent cognitive function is associated with health literacy. We hypothesized that cognitive function, independent of education, is associated with health literacy.
The sample included 537 African American, American Indian, and White men and women 60 years or older. Measures of cognitive function included the Mini-Mental State Examination (MMSE), Verbal Fluency, Brief Attention, and Digit Span Backward tests. Health literacy was assessed using the S-TOFHLA.
Cognitive function was associated with health literacy, independent of education and other important confounders. Every unit increase in the MMSE, Digit Span Backward, Verbal Fluency or Brief Attention was associated with a 20% (p<.001), 34% (p<.001), 5% (p<.01), and 16% (p<.01) increase in the odds of having adequate health literacy, respectively.
These results suggest that cognitive function is associated with health literacy in older adults with diabetes. Because poor cognitive function may undermine health literacy, efforts to target older adults on improving health literacy should consider cognitive function as a risk factor.
cognition; health literacy; diabetes
Various compounds in present human breath have long been loosely associated with pathological states (including acetone smell in uncontrolled diabetes). Only recently, however, the precise measurement of exhaled volatile organic compounds (VOCs) and aerosolized particles was made possible at extremely low concentrations by advances in several analytical methodologies, described in detail in the international literature and each suitable for specific subsets of exhaled compounds. Exhaled gases may be generated endogenously (in the pulmonary tract, blood, or peripheral tissues), as metabolic byproducts of human cells or colonizing micro-organisms, or may be inhaled as atmospheric pollutants; growing evidence indicates that several of these molecules have distinct cell-to-cell signaling functions. Independent of origin and physiological role, exhaled VOCs are attractive candidates as biomarkers of cellular activity/metabolism, and could be incorporated in future non-invasive clinical testing devices. Indeed, several recent studies reported altered exhaled gas profiles in dysmetabolic conditions and relatively accurate predictions of glucose concentrations, at least in controlled experimental conditions, for healthy and diabetic subjects over a broad range of glycemic values. Optimization of this methodology and validation in large-scale trials under a wider range of conditions is needed to determine its true potential to transition into practical clinical use.
breath tests; diabetes mellitus; diagnostic techniques and procedures; gases; volatile organic compounds
To determine how patients with Type 2 DM feel about a Motivational Interviewing (MI) intervention designed to promote positive behavior change.
Qualitative study using focus groups conducted by the same facilitator.
Family or general internal medicine practice clinics affiliated with an academic medical center and a community general hospital. One site consisted of primarily low income Hispanic patients.
Four focus groups consisting of nineteen adult patients with Type 2 Diabetes Mellitus solicited from a large NIH-funded randomized controlled trial on MI and Diabetes.
Across and within group analysis was performed on transcripts of the taped interviews. Patient perceptions of standard care were largely negative, with several individuals describing paternalistic and demeaning attitudes. Five themes related to MI emerged: Nonjudgmental Accountability, Being Heard and Responded to as a Person, Encouragement and Empowerment, Collaborative Action Planning & Goal Setting, and Coaching Rather than Critiquing.
Some patients with Type 2 Diabetes are receptive to motivational interviewing which is a provider approach that is more patient-centered and empowering than traditional care.
Motivational interviewing; patient satisfaction; patient-provider relationships; self care; behavior change
Elevated plasma plasminogen activator inhibitor-1 (PAI-1) levels were associated with higher incidence of type II diabetes. Elucidating the determinants of PAI-1 in various ethnicities may help to understand the susceptibility to developing diabetes. The aim of our study was to compare PAI-1 levels between Americans and the Japanese in the post-war generation and to elucidate the determinants of the PAI-1 levels.
We conducted a cross-sectional study on a total of 198 men aged 40–49 in the U.S. (Body-mass index (BMI): 27.0 ± 3.3 kg/m2) and Japan (BMI: 23.3 ± 3.1 kg/m2). Examination included physique measurement (BMI and waist girth), blood analysis (lipid profiles, glucose, insulin, C-reactive protein, and PAI-1), and life-style assessment by self-administered questionnaires.
PAI-1 levels were significantly lower in American than in Japanese men, even after adjustment for age, waist girth, cigarette smoking, habitual alcohol drinking, and other factors. In the Americans, waist girth, insulin, and cigarette smoking were significantly associated with PAI-1 levels, while waist girth and triglycerides were significantly associated with PAI-1 levels in the Japanese.
PAI-1 levels were significantly lower in American than in Japanese men and the determinants of PAI-1 levels differ for American and Japanese men aged 40–49.
PAI-1; US; Japan; epidemiology; post-war generation
Adolescents with type 1 diabetes reported more clinically significant depressive symptoms in the spring/summer months (22% in April–September) than in the fall/winter months (11% in October–March) (χ2 = 5.67, p = .018). This seasonal pattern was stronger in low-income adolescents than in adolescents from higher-income families.
Previous short-term studies evaluating U-500 insulin have reported improvements in glycemic control but with significant weight gain. This study was performed to examine the glycemic durability of U-500 insulin in highly insulin resistant subjects, and to determine if weight gain was continuous with use. Patients using U-500 insulin provided consent for chart reviews for up to 3 years prior to and 3 years after use of U-500 insulin. Charts were reviewed for physical and metabolic data from 53 subjects using U-500 insulin of which 20 used U-500 insulin for 3 years. Use of U-500 insulin led to an approximate 1% decrease in HbA1c within 3–6 months of use which was sustained for up to 3 years. Patients required increased insulin doses (by ~80%) over the first 6–12 months with a corresponding weight gain (~10 lbs) and a spike in hypoglycemia symptoms, but then insulin doses and body weight, as well as glycemic control and hypoglycemic symptoms, stabilized over subsequent follow up. Use of U-500 insulin in a clinical diabetes practice leads to sustained improvements in glycemic control following a period of insulin titration and weight gain. Despite the weight gain, glycemic control was sustained for up to 3 years.
insulin resistance; HbA1c; weight gain; hypoglycemia
To prospectively examine the association of retinal microvascular signs with incident diabetes and impaired fasting glucose (IFG) in a multi-ethnic population-based cohort.
The multi-ethnic study of atherosclerosis comprised Caucasians, African-Americans, Hispanics and Chinese aged 45–84 years. Retinal vascular calibre and retinopathy were quantified from baseline retinal photographs. Incident diabetes and IFG were ascertained prospectively.
After a median follow-up of 3 years, 243 (4.9%) people developed diabetes and 565 (15.0%) developed IFG. After adjusting for known risk factors, participants with wider retinal arteriolar calibre had a higher risk of developing diabetes [HR: 1.60; 95% CI: 1.12–2.29, p = 0.011 comparing highest with lowest arteriolar calibre tertile]. In ethnic subgroup analysis, the association between wider retinal arteriolar calibre and incident diabetes was stronger and statistically significant only in Caucasians [HR: 2.78; 95% CI: 1.37–5.62, p = 0.005]. Retinal venular calibre and retinopathy signs were not related to risk of diabetes or IFG.
Wider retinal arteriolar calibre is independently associated with an increased risk of diabetes, supporting a possible role for early arteriolar changes in diabetes development. This effect was largely seen in Caucasians, and not in other ethnic groups, and may reflect ethnic differences in susceptibility to diabetes from microvascular pathways.
Retinal microvascular calibre; Retinopathy; Diabetes; Impaired fasting glucose
A child with impaired fasting glucose was found to be heterozygous for a novel variant at c.659G>A in GCK and a variant at c.1663C>T in HNF1A. Structural modeling and clinical correlation suggests that the GCK variant causes monogenic diabetes while the variant in HNF1A is unlikely to be pathogenic.
MODY; Glucokinase; HNF1A protein
The association between depressive symptoms and patient-provider communication was examined in adult primary care patients with diabetes. Most communication was not patient-centered, but did not differ by level of patient’s depressive symptoms.
Oral health information was included in 89.5% of diabetes education programs in states with high diabetes prevalence compared to 85.9% in low prevalence states (P=0.22). However, management of dry mouth, demonstrations and return demonstrations of oral hygiene techniques were covered by 27.0%, 10.1% and <1% programs, respectively.
Diabetes Self-Management Training; Oral Health Education; Certified Diabetes Educators
Adolescents with type 1 diabetes are at increased risk for depression and anxiety, which can adversely affect diabetes management, glycemic control, and quality of life (QOL). However, systematic psychological screening is rarely employed. We hypothesized that higher depression and anxiety screener scores would predict higher HbA1c, less frequent blood glucose monitoring (BGM), and poorer QOL one year later. Raw screener scores were expected to be more robust predictors than cutoff scores.
150 adolescents age 13–18 with type 1 diabetes completed depression and anxiety screeners. One year later, blood glucose meters were downloaded to assess BGM frequency, HbA1c values were obtained, and caregivers rated the participants’ QOL. Separate regressions were conducted for each outcome, including demographic and medical covariates.
Higher depression scores predicted less frequent BGM (b=−0.05, p<.05) and poorer QOL (b=−0.71, p<.01), and higher state anxiety scores predicted higher HbA1c (b=0.07, p<.05). Continuous screener scores identified risk for 12-month outcomes more robustly than clinical cut-off scores.
Psychological screeners predict diabetes outcomes one year later. Future clinical research studies should explore whether psychological screening and referral for appropriate intervention can prevent deteriorations in diabetes management and control commonly seen during adolescence.
depression; anxiety; adherence; glycemic control; quality of life
The purpose of this study was to develop a measure of psychosocial barriers to adherence in adolescents with type 1 diabetes (T1D) and examine relationships to patient characteristics, adherence, and hemoglobin A1C (A1C).
Barriers to Diabetes Adherence (BDA) items were generated by researchers, clinicians, and patients. Adolescents aged 12–17 with T1D completed the BDA and an adherence measure. Hemoglobin A1C was obtained through medical chart review.
Factor analysis from 123 adolescents resulted in a 21-item, five-component solution that accounted for 63.09% of the variance. The components were stress and burnout, time pressure and planning, social support, parental autonomy support, and stigma. The BDA total and subscales were internally consistent. The BDA total and some components were associated with adherence and A1C. The BDA was the only predictor of A1C compared to demographic, clinical, and adherence variables (F 6.17, p<.05). Subjects with higher A1C (>8.5) showed a higher level of barriers (F 15.20, p<.001) and a differential profile of barriers (F 5.75, p<.05).
The BDA may be useful in research and clinical settings as a compliment to adherence measures and to tailor educational programs. Additional research is necessary to establish test-retest reliability and discriminant validity.
adherence; adolescents; type 1 diabetes; barriers; assessment
We examined cross-sectional associations of sex hormone binding globulin (SHBG) with glucose among women recent GDM (n=55). SHBG was associated with fasting glucose levels before and after adjustment for covariates (p=0.015), but not with 2-hour glucose. We conclude SHBG should be explored in prospective studies in GDM women.
gestational diabetes; postpartum; sex hormone binding globulin
India is experiencing an epidemic of type 2 diabetes (DM) in young adults. This study reports the prevalence of glucose intolerance, and insulin profiles, and their relationship to lifestyle factors in 2,218 young adults (aged 26-32 years; 997 urban, 1221 rural) in South India. They were drawn from a cohort of 10,691 individuals born during 1969-1973 in Vellore and nearby villages. Family history, socio-economic status, physical activity and tobacco and alcohol use were recorded. Oral glucose tolerance tests were performed for diagnosis (WHO recommendations). Insulin resistance and secretion were derived from plasma insulin concentrations. Median BMI was 20.0 kg/m2. The prevalence of type 2 DM and IGT was higher in urban than in rural subjects (3.7% vs 2.1%, p=0.02; 18.9% vs 14.3%, p=0.002 respectively), while prevalence of IFG was similar in urban and rural populations (3.8% vs 3.4%, p=0.04). Type 2 DM, IGT, IFG or higher insulin resistance and increment were associated with higher socio-economic status (more household possessions) and higher percentage body fat, body mass index and waist/hip ratio. Insulin increment was lower in men with higher alcohol consumption. Our data suggest high levels of glucose intolerance in young rural and urban adults highlighting an urgent need for preventive action to avert a public health catastrophe in India.
Impaired glucose tolerance (IGT); impaired fasting glycaemia (IFG); type 2 diabetes mellitus (Type 2 DM); insulin increment; insulin resistance
To study the relationship of newborn size and post-natal growth to glucose intolerance in south Indian adults.
Research design and Methods
2,218 men and women (mean age 28 years) were studied from a population-based birth cohort born in a large town and adjacent rural villages. The prevalence of adult diabetes mellitus [DM] and impaired glucose tolerance [IGT], and insulin resistance and insulin secretion (calculated) were examined in relation to BMI and height at birth, and in infancy, childhood and adolescence and changes in BMI and height between these stages.
Sixty-two (2.8%) subjects had type 2 diabetes (DM) and 362 (16.3%) had impaired glucose tolerance (IGT). IGT and DM combined (IGT/DM) and insulin resistance were associated with low childhood body mass index (BMI) (p<0.001 for both) and above-average BMI gain between childhood or adolescence and adult life (p<0.001 for both). There were no direct associations between birthweight or infant size and IGT/DM; however, after adjusting for adult BMI, lower birthweight was associated with an increased risk.
The occurrence of IGT and Type 2 DM is associated with thinness at birth and in childhood followed by accelerated BMI gain through adolescence.
Type 2 diabetes mellitus; impaired glucose tolerance; insulin resistance; childhood body mass index; young adulthood
We compared the prevalence and treatment of type 2 diabetes across Asian American subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese) and Non-Hispanic Whites (NHWs) in a Northern California healthcare system.
A three-year, cross-sectional sample of patient electronic health records was accessed to compare diabetes prevalence in 21,816 Asian and 73,728 NHWs aged 35+ years. Diabetes was classified through ICD-9 codes, abnormal laboratory values, or use of oral anti-diabetic medication. Multivariate adjusted prevalence rates for each Asian subgroup, and adjusted odds ratios (OR) relative to NHWs, were compared.
Age-adjusted prevalence ranged from 5.8%-18.2% (women) and 8.1%-25.3% (men). Age-adjusted ORs of Asian subgroups ranged 1.11-3.94 (women) and 1.14-4.56 (men). The odds of diabetes were significantly higher in Asian Indians (women OR 3.44, men OR 3.54) and Filipinos (women OR 3.94, men OR 4.56), compared to NHWs. Results for Asian Indians and Filipinos were similar with age-and-BMI adjustment. Treatment rates across subgroups were 59.7-82.0% (women) and 62.9-79.4% (men).
Heterogeneity exists in the prevalence of diabetes across Asian subgroups, independent of obesity prevalence. Asian Indian and Filipino subgroups had particularly high prevalence of diabetes when compared to NHWs. Future studies should explore these clinically important differences among Asian subgroups.
diabetes; prevalence; Asian American; racial/ethnic subgroup
Parental history of diabetes and specific gene variants are risk factors for type 2 diabetes, but the extent to which these factors are associated is unknown.
We examined the association between parental history of diabetes and a type 2 diabetes genetic risk score (GRS) in two cohort studies from Finland (population-based PPP-Botnia Study) and the US (family-based Framingham Offspring Study).
Mean (95% CI) GRS increased from 16.8 (16.8–16.9) to 16.9 (16.8–17.1) to 17.1 (16.8–17.4) among PPP-Botnia participants with 0, 1, and 2 parents with diabetes, respectively (ptrend=0.03). The trend was similar among Framingham Offspring but was not statistically significant (p=0.07). The meta-analyzed p value for trend from the two studies was 0.005.
The very modest associations reported above suggest that the increased risk of diabetes in offspring of parents with diabetes is largely the result of shared environmental/lifestyle factors and/or hitherto unknown genetic factors.
Type 2 diabetes mellitus; genetic risk score; family history
Background and Aims
Impaired glucose tolerance based on 2-hr glucose levels is more predictive of future cardiovascular disease and more sensitive in detecting earlier diabetes compared to impaired fasting glucose. However, the 1-hr OGTT may be even more sensitive than the 2-hr. We assessed the relative value of 1-hr OGTT by exploring its relationship with adiposity and other measures of glucose homeostasis.
Methods and Results
Ninety four overweight/obese individuals free of diabetes and major cardiovascular conditions were included in the analyses. We adjusted for age, gender, smoking status and physical activity. One-hr OGTT showed similar partial correlations with fasting glucose and 2-hr OGTT (r= 0.60 and 0.64 respectively). Fasting glucose, fasting insulin and HOMA correlated better with 1-hr OGTT (r= 0.60, 0.47 and 0.52) than with 2-hr OGTT (r= 0.50, 0.41, and 0.45). BMI and waist circumference also showed stronger correlation with 1-hr (r= 0.31, 0.29), compared to 2-hr OGTT (r= 0.16, 0.16) or fasting glucose (r= 0.23, 0.22). Metabolic syndrome was associated similarly with 1-hr and 2-hr OGTT.
The 1-hr OGTT correlates well with both fasting glucose and 2-hr OGTT and shows similar or higher associations with obesity measures. The 1-hr OGTT has potential utility in epidemiologic studies.
Type 2 diabetes; 1-hr OGTT; glucose abnormalities; abnormal glucose homeostasis; 2-hr OGTT
To determine mutable risk factors for asymptomatic diastolic dysfunction in ethnic minority patients newly diagnosed with type 2 diabetes.
We recruited consecutive adults with newly diagnosed diabetes who had no signs or symptoms or history of heart disease. All patients received standardized evaluation including interview, physical examination, laboratory tests and echocardiogram with tissue Doppler studies. We used logistic regression models to identify mutable risk factors for diastolic dysfunction.
Among 126 study subjects (52% women, age 45 ± 10 years, BMI 33 ± 7, 42% with hypertension, 100% ejection fraction ≥50%), evidence of diastolic dysfunction was present in 64 (51%). After controlling for age, heart rate and blood pressure, independent predictors of diastolic dysfunction included physical inactivity (OR: 2.3; 95% CI: 0.9–6.1; P = 0.08) and glucose (OR: 4.9; 95% CI: 1.4–17.8; P = 0.02). Physical inactivity was associated with early diastolic dysfunction (impaired relaxation), whereas epicardial fat thickness and glucose levels were associated with late diastolic dysfunction (impaired compliance). The hs-CRP and BNP levels were not associated with diastolic dysfunction.
Asymptomatic diastolic dysfunction was prevalent among urban minority patients newly diagnosed with diabetes. Important differences exist among factors that affect early and late diastolic function that may have prognostic and therapeutic implications.
Heart failure; Prevention; Metabolic syndrome; Complications
In this study we evaluate the reliability and validity of existing Health Beliefs Model (HBM) scales developed to assess HBM domains in a population of patients with both diabetes and serious mental illness (SMI). While diabetes medication adherence has frequently been evaluated through the lens of the HBM, it is unclear if developed scales are reliable and valid in patients with SMI.
We surveyed 152 veterans with diabetes and SMI. Domains of the HBM assessed included perceived benefits, side effects and barriers to diabetes medication taking, perceived susceptibility to and severity of diabetes, diabetes self-efficacy, diabetes locus of control, and perceived diabetes control.
HBM scales showed good internal reliability within a SMI population, with Cronbach alphas ranging between 0.73 and 0.86 for all scales assessed except one. HBM scales also showed associations with self reported diabetes medication adherences in six of the ten domains.
Scales assessing diabetes specific domains of the HBM exhibit both reliability and validity in patients with both diabetes and SMI.
Diabetes; Serious Mental Illness; Health Beliefs Model
This study aimed to evaluate the influence of insulin resistance status on weight changes in non-obese women who followed a home-based exercise program and slight caloric restriction over a period of 12 months. Middle-aged (25–45 yr), non-obese (body mass index of 23–29.9 kg/m2) women were randomly assigned to control (CG) or home-based exercise group (HB). The HB group received a booklet explaining the physical exercises to be practiced at home at least three times per week (40 min/session). Both groups were required to follow a small energy restriction of 100–300 calories per day. For the analysis, women were stratified in two groups according to baseline insulin sensitivity: NIR (non-insulin resistant; n=121) and IR (insulin resistant; n=64). Women classified as IR at baseline had greater weight loss after 12 months of follow-up (−1.6 kg vs. −1.1 kg; p=0.01), and HB exercise helped to reduce weight only among NIR women (−1.5 vs. −0.7; p=0.04); no differences were observed between intervention groups for IR women (−1.5 vs. −1.7; p=0.24). There were no differences between IR and NIR groups for lipid profile after adjustment for weight changes. Insulin resistance facilitated weight loss, and home-based exercise promoted greater weight loss only in non-insulin resistance women.
Diabetes; Prevention; Weight change; Obesity; Physical activity