Jennifer M Kolb, Nicole R Kitos, Ambili Ramachandran, Jenny J Lin, Devin M Mann
Objective: This study assessed the baseline knowledge, perceptions, attitudes and behaviors of prediabetes patients in order to tailor a new technology-enhanced primary care-based lifestyle modification intervention.
Methods: Patients with a diagnosis of prediabetes were enrolled in a randomized, controlled pilot study, Avoiding Diabetes Thru Action Plan Targeting (ADAPT), a technology-based intervention to promote action plan discussions around patient-selected behavior change goals.
Results: A total of 54 adults (82% female) were enrolled in the pilot study. Most (89%) had comorbid conditions and mean BMI was 36. Participants exhibited high risk of diabetes knowledge (knowledge score 20 on a 32 point scale) and high levels of willingness to make changes to decrease diabetes risk. Number of daily steps was inversely correlated with perceived physical activity (r=-0.35082, p<0.001). Poorer scores on diet quality were inversely correlated with BMI.
Conclusion: Participants in this sample demonstrated requisite levels of knowledge, self-efficacy, motivation and risk perception for effective behavior change. These data suggest that primary care-based prediabetes interventions can move beyond educational goals and focus on enhancing patients' ability to select, plan and enact action plans.
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Pub Date : 2013-09-14DOI: 10.14302/issn.2374-9431.jbd-13-218
Gregory Oxenkrug, Rebecca Ratner, Paul Summergrad
The increased association between depression and diabetes mellitus is generally acknowledged. Recent studies suggest that depression leads to diabetes. However, the underlying molecular mechanisms for this association remain unclear. Literature and our data indicate that inflammatory and/or stress factors in depression up-regulate tryptophan (TRP) conversion into kynurenine (KYN), a substrate for nicotinamide adenine dinucleotide (NAD) biosynthesis. Deficiency of vitamin B6, a cofactor of the key enzymes of KYN - NAD pathway, shunts KYN metabolism from formation of NAD towards production of xanthurenic (XA) and kynurenic (KYNA) acids. Human and experimental studies reveal that XA, KYNA and their metabolites interfere with production, release and biological activity of insulin. We propose that inflammation- and/or stress-induced up-regulation of TRP - KYN metabolism in combination with vitamin B6 deficiency is one of the mechanisms mediating increased risk of diabetes in depression. Consequently, monitoring formation of diabetogenic KYN derivatives might help to identify subjects-at-risk for the development of diabetes. Pharmacological down-regulation of the TRP - KYN - NAD pathway and maintenance of adequate vitamin B6 status might help to prevent the development of diabetes in depression and other conditions associated with inflammation/stress- induced excessive production of KYN and vitamin B6 deficiency, e.g., obesity, cardiovascular diseases, aging, menopause, pregnancy, and hepatitis C virus infection.
抑郁症与糖尿病之间的关联性增加已得到普遍承认。最近的研究表明，抑郁症会导致糖尿病。然而，这种关联的潜在分子机制仍不清楚。文献和我们的数据表明，抑郁症中的炎症和/或应激因素会上调色氨酸（TRP）向犬尿氨酸（KYN）的转化，而犬尿氨酸是烟酰胺腺嘌呤二核苷酸（NAD）生物合成的底物。维生素 B6 是 KYN - NAD 途径中关键酶的辅助因子，缺乏维生素 B6 会使 KYN 代谢从形成 NAD 转向产生黄嘌呤酸 (XA) 和犬尿苷酸 (KYNA)。人体和实验研究表明，XA、KYNA 及其代谢物会干扰胰岛素的产生、释放和生物活性。我们认为，炎症和/或压力诱导的 TRP - KYN 代谢上调与维生素 B6 缺乏相结合，是抑郁症患者糖尿病风险增加的机制之一。因此，监测致糖尿病 KYN 衍生物的形成可能有助于识别糖尿病高危人群。药物下调 TRP - KYN - NAD 通路和维持充足的维生素 B6 状态可能有助于预防抑郁症和其他与炎症/应激引起的 KYN 过度生成和维生素 B6 缺乏有关的疾病（如肥胖、心血管疾病、衰老、更年期、妊娠和丙型肝炎病毒感染）中糖尿病的发生。
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