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Objective: In this secondary analysis of the Rural Engagement in Primary Care for Optimizing Weight Reduction (RE-POWER) randomized trial, the authors determined the effectiveness of weight-loss interventions in people with diabetes compared with those without diabetes living in rural areas., Methods: The RE-POWER study was a randomized trial designed to determine the effectiveness of nonpharmacological behavioral weight-loss interventions in rural participants with obesity, comparing the individual in-clinic visit model to in-person group sessions and phone group sessions over 24 months. In this secondary analysis, weight loss was compared in participants with and without diabetes. The effects of factors such as medications, insulin, and behavioral factors were compared., Results: Participants with diabetes were less likely to lose weight during the study compared with those without diabetes up to 18 months (4.12% vs. 5.31%; net difference = 1.46%; 95% CI: 0.63%-2.28%). Participants with diabetes on insulin lost less weight than patients with diabetes not on insulin at 6 months (4.52% vs. 6.88%; net difference = 2.35%; 95% CI: 0.55%-4.16%). The group with diabetes had significantly lower changes in blood pressure and lipid parameters versus the group without diabetes., Conclusions: Patients with diabetes in rural areas were less likely to lose weight, and metabolic parameters were less responsive to weight loss, compared with patients without diabetes., (© 2022 The Obesity Society (TOS). This article has been contributed to by US Government employees and their work is in the public domain in the USA.)

Endothelial progenitor cells (EPCs) are vital for the maintenance and repair of the endothelium. Decreased EPC number and function have been associated with increased cardiovascular (CVD) risk. Patients with diabetes have decreased number of circulating EPCs and decreased EPC function. This may account for some of the increased CVD risk seen in patients with diabetes that is not explained by traditional risk factors such as glycemic control, dyslipidemia and hypertension. Recent studies seem to indicate that drugs commonly used in diabetes patients such as metformin, thiazolidinediones, GLP-1 agonists, DPP-4 inhibitors, insulin, statins and ACE inhibitors may increase EPC number and improve EPC function. The mechanisms by which these drugs modulate EPC function may involve reduction in inflammation, oxidative stress and insulin resistance as well as an increase in nitric oxide (NO) bioavailability. This review will discuss the evidence in the literature regarding the above mentioned topics., (Published by Elsevier Inc.)

Kidney transplantation is being performed more frequently for individuals with end stage renal disease (ESRD) due to improved survival and quality of life compared to long-term dialysis. Though rates decrease after transplant, cardiovascular disease (CVD) remains the most common cause of death after kidney transplant. New-onset diabetes after transplant (NODAT), a common complication following kidney transplantation, and pre-transplant diabetes both significantly increase the risk for CVD. Several other risk factors for CVD in kidney transplant recipients have been identified; however, optimal therapy for controlling the risk factors of CVD after kidney transplantation, including NODAT and pre-transplant diabetes, is not well defined. In the following review we will discuss the role of traditional and non-traditional risk factors in CVD after kidney transplant and the mechanisms involved therein. We will also examine the current literature regarding treatment of these risk factors for the prevention of CVD. Finally, we will review the current recommendations for pre- and post-transplant cardiovascular evaluation and management.

Objectives: Novel interventions are needed for long-term maintenance of diabetes control. We studied the effects of a group diabetes clinic (GDC) on diabetes control when compared to usual care with primary care providers (PCP)., Research Design/methods: Data from the electronic medical records of 56 patients were collected. Twenty-nine patients were in the group diabetes clinic (GDC) while 27 patients followed with their PCP. Outcome variables, A1c, LDL, and blood pressure (BP) were measured at baseline and every 6 months for a 2 year period., Results: A1c, LDL and BP were no different at the end of 2 years in the GDC cohort and the PCP cohort. Slight upward trend in time was detected for A1c in both groups, but more so in the PCP group., Conclusion: GDC can lead to maintenance of diabetes control in a population with difficult to manage diabetes as effectively as and more efficiently than usual care., (Published by Elsevier Ltd.)

Objective: Diabetes mellitus is a major public health problem with a prevalence of 6-7%. Self-care behaviors play a major role in the control of diabetes. Apathy is characterized by loss of initiative and motivation. Apathy may interfere with self-care behavior and glycemic control. The primary objective was to determine the prevalence of apathy in patients with diabetes. The secondary objective was to determine if there was an association between clinically significant apathy and factors that affect glycemic control., Research Design and Methods: We conducted a cross-sectional study of 100 patients with diabetes who were assessed with the Apathy Evaluation Scale-Clinician version (AES-C), the Hamilton Depression Scale (HAM-D), and the Self-Care Inventory (SCI). For this study we defined clinically significant apathy as AES-C score of >30. We excluded patients with a HAM-D score of >14 (n=19) to avoid confounding from depression. T-tests were used to compare clinical characteristics between subjects with and without apathy. Multiple linear regression modeling was used to investigate the association between clinically significant apathy and factors that affect glycemic control., Results: Fifty (61.7% of 81) patients had clinically significant apathy. Compared to the non-apathetic patients, those with apathy had a higher mean BMI (30.5 kg/m(2) versus 34.1 kg/m(2) (p=0.03)) and were less likely to adhere to an exercise plan (p=0.01) or insulin regimen (p=0.003). After adjustment for age, BMI, cholesterol, mild depression and the average Self-Care Index score, the mean HbA1C level was 0.66% greater for apathetic compared to non-apathetic subjects (P=0.08)., Conclusion: Apathy is highly prevalent in patients with diabetes without depression. Apathy may have a negative impact on self-care behaviors and diabetes control.