FOCUS ON T2D

EDUCATOR WATCH

FOCUS ON T2D:

EMERGING RESEARCH ON COFFEE; MORE ON GENETICS AND EXERCISE

FOCUS ON T2D: EMERGING RESEARCH ON COFFEE; MORE ON GENETICS AND EXERCISE
Each issue, EducatorWatch highlights some of the most interesting and relevant clinical studies from that stack of journals on your desk. Each study includes Educator Take-Home Points with insights from diabetes educators about what this emerging research could mean to you—and your patients. In this issue, we focus on type 2 diabetes (T2D).

UPPING COFFEE CONSUMPTION COULD CUT T2D DIABETES RISK

For some time, coffee consumption has been associated with a lower risk of T2D, but until recently, little was known about how changes in the amount people drink could affect subsequent risk.

Now, a large retrospective study spanning 20 years has found that drinking more coffee over a 4-year period may decrease the risk of T2D in the subsequent 4 years. Using a validated food-frequency questionnaire to measure changes in coffee consumption, researchers followed more than 120,000 men and women, who self-reported any diagnoses of T2D.

Researchers identified 7,269 cases of T2D during the study period [Bhupathiraju et al]. After controlling for age, weight, physical activity, smoking, alcohol consumption, and a family history of diabetes, researchers found that people who increased their coffee intake by more than an 8-ounce cup a day during a 4-year period had an 11 percent lower risk of diabetes during the subsequent 4 years compared with those whose consumption remained steady. Additionally, people who decreased coffee consumption by more than 1 cup had a 17 percent higher risk.

EDUCATOR TAKE-HOME POINT FROM HOLLY JAKITS, MS, RD, CDE: The results from this large retrospective analysis are stimulating (no pun intended), given the major role coffee plays in our cultural diets. We’ve had more substantial bodies of evidence supporting the association between coffee intake and decreased risk of neurological disorders like dementia and Alzheimer’s disease, so it is exciting to see the long-term risk reduction for T2D as well. The association between coffee intake and long-term diabetes risk reduction in this analysis brings to mind the EDIC trial, which demonstrated that improvements in glycemic control in the immediate term can have a long-term protective effect even if glycemic control deteriorates [Diabetes Care.1999;22:99-111]. We must still clarify with our patients that it’s important what they put in their coffee, and the sugar-laden, blended coffee drinks marketed by major coffee chains are not an acceptable form of coffee to decrease the risk of T2D diabetes!

EDUCATOR TAKE-HOME POINT FROM TERRI YEAGER, MSN, CRNP, CDE, BC-ADM: This study of both women and men utilizing cohorts from the Nurses’ Health Study and the Health Professionals Follow-Up Study provided a positive outcome for patients who enjoy their cuppa joe. As with all dietary recommendations, we should continue to advise our patients: All good things in moderation.

Sources:
Bhupathiraju SN, et al. Changes in coffee intake and subsequent risk of type 2 diabetes: three large cohorts of U.S. men and women. Diabetologia. 2014;57:1346-1354.
Epidemiology of Diabetes Interventions and Complications (EDIC): Design, implementation, and preliminary results of a long–term follow–up of the Diabetes Control and Complications Trial cohort. Diabetes Care. 1999;22:99-111.


PATIENTS AND EXERCISE: COULD GENETICS REALLY BE TO BLAME?

When it comes to exercise in patients with T2D, do some patients truly have a “programmed response to fail?” Research has found that some patients with T2D do not see any improvement in blood glucose control even when they engage in a supervised exercise regimen. A recent study took a closer look at the percentage of patients who fall into this category and the genetic factors that may be to blame.

The researchers conducted a systematic review of the relevant clinical literature (both human and animal studies) as well as selected unpublished studies. They found the way in which individuals with T2D respond to supervised exercise training can be highly variable when it comes to glucose homeostasis, insulin sensitivity, and muscle mitochondrial density.

Overall, the researchers found that 15 to 20 percent of people with T2D fail to improve their metabolic health with exercise [Stephens et al]. Classic genetic studies have shown that the extent of the exercise training response is largely heritable, whereas emerging research has demonstrated that DNA hypomethylation is linked to the exercise response in skeletal muscle. DNA sequence variation and/or epigenetic modifications may, therefore, influence the exercise training response.

The authors have called for more studies to uncover the mechanisms of exercise resistance in order to personalize interventions in T2D patients with blunted metabolic response. Identifying novel approaches to treating these patients is critical to formulating effective treatment and prevention strategies, the authors added.

EDUCATOR TAKE-HOME POINT FROM HOLLY JAKITS, MS, RD, CDE: While some patients with T2D may not see metabolic/glycemic improvement with exercise as indicated in this review, they need not become discouraged. Although further research is warranted to learn tailored strategies for exercise responders versus nonresponders, we must still promote consistent yet sustainable exercise regimens for patients with T2D, as we know exercise can stimulate other positive behaviors such as healthier food choices and overall improvement in energy, mood, and quality of life. Once strategies for identifying responders and nonresponders are developed, we will be able to better design comprehensive diabetes management programs for our patients.

EDUCATOR TAKE-HOME POINT FROM TERRI YEAGER, MSN, CRNP, CDE, BC-ADM: Exercise may be one of the most challenging components of a healthy lifestyle and one that nearly everyone aspires to conquer. However, this study looks at what happens when the outcome does not meet the expectation, and 15 to 20 percent of individuals with T2D do not receive the positive return on investment that they hope for. While exercise provides benefits for most, these 15 to 20 percent are not gaining the improvements in metabolic health from exercise that others experience. It is critical to treatment and prevention strategies to identify people with T2D who have a blunted metabolic response to exercise and investigate the underlying mechanisms that might predict this “programmed response to fail.” In the interim, we need to let our patients know that there can be varying metabolic responses to exercise and that they should not feel that they have failed in meeting their goals. Providing this information and encouragement is key to reinforcing the importance of exercise and other healthy lifestyle initiatives for those individuals with T2D.

Source: Stephens NA, et al. Resistance to the beneficial effects of exercise in type 2 diabetes: Are some individuals programmed to fail? J Clin Endocrinol. Published online Nov. 20, 2014.