Sophie Bersoux

Newer management strategies are being evaluated to treat obesity, which continues to increase worldwide. After 12 h of fasting, the body switches from glucose to fat metabolism, regulating protein synthesis and autophagy. These cellular responses are central to the metabolic benefits of time-restricted eating (TRE), independent of calorie restriction and weight loss, and they have heightened interest in TRE regimens. Controversy remains, however, regarding the benefits of TRE regimens. We reviewed the current literature and concluded that TRE is equivalent to calorie restriction for weight loss and has positive effects for patients with diseases such as nonalcoholic fatty liver disease, cancer, and cardiovascular disease.

Release date: December 1, 2017Expiration date: November 30, 2018Estimated time of completion: 1 hourClick here to start this CME activity.Click here to complete post-test and CME certificate.ABSTRACTWeight-loss drugs are being evaluated for their role in obesity management. This article reviews the available weight-loss drugs, their efficacy and side effects, and their best clinical use.

BACKGROUND Cross‐sectional data on inpatient glucose control in a large sample of US hospitals are now available, but little is known about changes in glycemic control over time in these institutions. OBJECTIVE To evaluate trends in glycemic control in US hospitals over 2 years. DESIGN Retrospective analysis. METHODS Point‐of‐care blood glucose (POC‐BG) test results at 126 hospitals during January to December 2007 and January to December 2009 were extracted using the Remote Automated Laboratory System‐Plus (Medical Automation Systems, Charlottesville, VA), and patient‐day‐weighted mean glucose levels were compared. SETTING/PATIENTS Hospitalized patients. RESULTS A total of 12,541,929 POC‐BG measurements from 1,010,705 patients were analyzed for 2007, and 10,659,418 POC‐BG measurements from 656,206 patients were analyzed for 2009. Patient‐day‐weighted mean POC‐BG in 2009 decreased by 5 mg/dL in the non‐intensive care unit (non‐ICU) data compared with that in 2007 (154 mg/dL vs 159 mg/dL, respectively; P < 0.001). However, POC‐BG values were clinically unchanged in intensive care unit (ICU) data from 2009 vs 2007 (167 mg/dL vs 166 mg/dL; P < 0.001). From 2007 to 2009, the proportion of patient‐day‐weighted mean POC‐BGs that were >180 mg/dL declined from 28% to 25% in non‐ICU patients (P < 0.001), but not in ICU. Decreases in patient‐day‐weighted mean POC‐BG values in non‐ICU patients were significant regardless of hospital size, type, and geographic region (all P < 0.001), but similar decreases were not found in ICU data. CONCLUSIONS In this first analysis of glucose changes in US hospitals, improvements over 2 years occurred in non‐ICU patients. Ongoing analysis will determine whether this trend continues. Journal of Hospital Medicine 2013;8:121–125. © 2012 Society of Hospital Medicine

Lifestyle changes delay onset of type 2 diabetes, and at risk persons should have access to outpatient diabetes prevention programs. Only limited data exist about the success of a diabetes prevention program in an outpatient clinic setting. The Diet-Exercise-Activity-Lifestyle (DEAL) program was established for patients with prediabetes and consists of 4 weeks of nutrition classes, exercise counseling, and medical follow-up visits at 6 and 12 months (1). To evaluate program effectiveness, changes in weight, fasting glucose, and 2-hr glucose following a 75 gm oral glucose tolerance test were determined in patients enrolling in DEAL between January 2007 and August 2009. Mean age of 221 participants at enrollment was 62 years, weight 87.4 kg, BMI 31.2 kg/m2, fasting glucose 109 mg/dL and 2-hr glucose 138 mg/dL; 67% were women, 89% white; 56% had isolated impaired fasting glucose, 5% had only impaired glucose tolerance, and 39% had both. Over 80% of participants attended all nutrition classes, 62% kept their 6 month medical follow-up appointment but only 45% kept their 12 month visit. Among those with 6 month follow-up 59% had lower fasting glucose levels (decreasing from 110 mg/L to 103 mg/dL, P <.0001) and 59% had improvement in 2-hr glucose values (decreasing from 146 mg/dL to 115 mg/dL, P <.0001); 7% developed diabetes. Additionally, 61% of participants lost weight at 6 months (decreasing from 87.7 kg to 84.2 kg, P <.0001) with average reduction of 4.0%. Patients with lower fasting glucose, 2-hr glucose, and weight at 6 months had significantly higher values at time of enrollment compared to persons who did not show improvement. There was no significant difference in the number of nutrition classes attended between persons who did and did not show improvement at 6 months. At 12 months (evaluated through September 2010 for patients enrolling in August 2009) there was no significant change in weight, fasting glucose, or 2-hr glucose compared to 6 months. Our analysis shows that most DEAL participants were able to lower their glucose levels and weight, but some did not benefit and factors underlying non-response need to be identified. As there was no additional improvement in outcomes between 6 and 12 months, changing medical follow-up visits to 3 and 6 months may be reasonable and could possibly reduce attrition with a more compressed time frame. Ongoing experience and analysis should permit revisions to DEAL to assure maximal benefit to participants. Bersoux S et. al. An Outpatient-Based Clinical Program for Type 2 Diabetes Prevention. Endocrine Practice. 2010;16:21-29. Nothing to Disclose: CMS, SB, MHL, RTA-F, SSF, CLO, PMV, CBC