Diabetes Research and Clinical Practice - Volume 106 - Supplement 1 - November 2014 - page 8

Diabetes Research and Clinical Practice 106S1 (2014) S1–S41
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Oral presentation abstracts
Behavioural interventions and
management tools
OP1
PEER LEADERS ACCELERATED TRAINING INITIATIVE
TO UNLEASH POTENTIAL OF MENTORSHIP (PLATINUM)
PROGRAM: A 4-YEAR OBSERVATIONAL STUDY ON THE
EFFECTS OF PROVIDING PEER SUPPORT IN PEOPLE WITH
TYPE 2 DIABETES
J.M. Yin
1
, R. Wong
2
, S.M. Au
3
, H. Chung
4
, M. Lau
5
, C.C. Tsang
5
,
R. Ozaki
2
, W.Y. So
1
, G.T.C. Ko
1
, A. Luk
1
, R. Yeung
1
, J. Chan
1
.
1
Medicine and Therapeutics, Chinese University of Hong Kong,
2
Diabetes and Endocrine Centre, Prince of Wales Hospital,
3
Diabetes and Endocrine Centre, Ruttonjee Hospital,
4
Asia Diabetes
Foundation, Prince of Wales Hospital,
5
Diabetes and Endocrine
Centre, Alice Ho Mui Ling Nethersole Hospital, Hong Kong SAR,
China
Background:
Diabetes self-management is often emotionally
and physically taxing, demanding lifelong commitment to
medication adherence and lifestyle modification. Given the
importance of contact time to maintain learned behaviors,
peer support has been recommended as a means to improve
long term self-management. We examined the effects of
(1) participating in a peer supporter “train-the-trainer”
program and (2) providing peer support on metabolic and
cognitive–psychological-behavioral parameters in Chinese
patients with type 2 diabetes.
Method:
Patients with type 2 diabetes with fair glycemic
control (HbA1c
<
8%) were invited to join a train-the-trainer
program composed of four eight-hour interactive workshops
in 2009, with a view to become peer supporters (study group).
If agreeable, these patients were each assigned to provide
10 peers with structured peer support for at least one year
as of 2010, and a voluntary extension of 3 additional years.
A group of patients (N= 60) who did not attend the training
program under usual care were matched for age, education,
disease duration, and glycemic control as control group.
We compared changes in HbA1c between month 0 (M0)
and month 6 (M6) along with clinical, psychological, and
behavioral assessments. After 4 years, we examined the
changes in metabolic control (HbA1c, blood pressure, lipid
profiles) in both groups in an usual care setting.
Result:
Among 79 patients who joined the train-the-trainer
program, 59 (mean±SD age: 55.6±11.6 years, disease duration:
11±6.7 years, 35%male) completed the program and 33 agreed
to become peer supporters (agreed group) and 26 declined
(refused group). In the control group (age: 56.5±10.9 years,
disease duration: 8.3±6.62 years, 65% male), HbA1c has risen
from 7.1±0.5% at M0 to 7.3±1.1% at M6 (p = 0.12) compared
to no change in the study group (7.1±0.3 at M0 vs 7.1±1.1
at M6) (p = 0.019, between group). The study group also had
better lipid control and improved self-care activities at M6.
Amongst the study group, the agreed group had lower fasting
plasma glucose and improved health-related quality of life
than the refused group at M6. Amongst the agreed group, 21 of
the 33 peer supporters joined the 3-year voluntary extension
period and 17 completed the program. After 4 years, all peer
supporters (N= 33) maintained their HbA1c (7.2±0.6% in 2013
vs 7.0±0.19% in 2009, p = 0.07), compared to an increase in
the refused group (7.8±0.8% vs 7.1±0.4%, p = 0.02) and control
group (8.1±0.6% vs 7.1±0.5%, p = 0.012).
Conclusion:
By providing ongoing peer support to others,
patients with diabetes benefited with improved self-care,
psychological health, and maintained metabolic control over
four years. These preliminary data suggested that enabling
patients to become peer supporters might be a useful strategy
for long-term diabetes management.
OP2
RESOLUTION OF INADEQUATE EATING BEHAVIOR
AND ACCELERATED GLUCOSE APPEARANCE BY
SENSOR-AUGMENTED NUTRITION TRAINING (SANT) IN
PATIENTS WITH NONINSULINOMA PANCREATOGENOUS
HYPOGLYCAEMIA SYNDROME (NIPHS) AFTER RYGB
K.G. Rett
1,2
, R. Weiner
2
, H. Schreiweis
1
, I. Skudelny
1
,
E. Fischer
1
, K. Krieger
1
, E. Weitz
1
.
1
Dept. for Endocrinology and
Diabetes,
2
German Obesity Center, Krankenhaus Sachsenhausen,
Frankfurt, Germany
Background:
The gastric bypass procedure (RYGB) has been
said to promote prudent eating behaviour by altering food
preference and reducing intake of fat and sweet foods thereby
contributing to the favourable RYGB-effects on metabolic
control and body weight [1]. On the other hand, recent clinical
and experimental data suggest accelerated appearance of
oral glucose due to the anatomic alterations and metabolic
reprogramming of the Roux limb [2–4]. We therefore
assessed both eating behavior and glucose excursions
in RYGB subjects with noninsulinoma pancreatogenous
hypoglycaemia syndrome (NIPHS) – a condition with high
glucose variability – under real life conditions.
Method:
In 22 patients (20f, 2m) who had undergone RYGB
for obesity (BMI 45.5±2.2 kg/m
2
; 80% type 2 diabetes) and
in whom both NIPHS and inadequate postbariatric eating
behavior had been diagnosed during a week of continuous
glucose monitoring (CGM; Dexcom G4, lower alarm limit:
70mg/dl) 6–18 months after the bariatric procedure (BMI
36.7±2.7 kg/m
2
, sensor-augmented nutrition training (SANT)
was performed. It was our aim to modify eating behavior
and dumping-like postprandial glucose excursions. During
one week of SANT, participants were asked to comply with
defined nutrition targets (
<
30% fat/
>
40% carbs/
>
25% protein/
<
20g sucrose/
>
25g fiber) and record nutrition and physical
activity in detailed diaries.
Result:
(mean±SEM): Average daily energy intake (1540±129
kcal) was hypocaloric, whereas fat consumption exceeded
general recommendations both in absolute (68±6g) and
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