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Depressive symptoms improve over 2 years of type 2 diabetes treatment via a digital continuous remote care intervention focused on carbohydrate restriction.

ABSTRACT: Depressive symptoms are prevalent among people with type 2 diabetes (T2D) and, even at low severity levels, are associated with worse diabetes outcomes. Carbohydrate restriction is an effective treatment for T2D but its long-term impacts on depressive symptoms are unclear. In the current study we explored changes in depressive symptoms over 2 years among 262 primarily non-depressed T2D patients participating in a continuous remote care intervention emphasizing carbohydrate restriction. Subclinical depressive symptoms decreased over the first 10 weeks and reductions were maintained out to 2 years. Increased frequency of blood ketone levels indicative of adherence to low carbohydrate eating predicted decreases in depressive symptoms. Concerns have been raised with recommending restrictive diets due to potential negative impacts on quality-of-life factors such as mood; however, results of the current study support positive rather than negative long-term impacts of closely monitored carbohydrate restriction on depressive symptoms.

SUBMITTER: Adams RN

PROVIDER: S-EPMC9160138 | biostudies-literature | 2022 Jun

REPOSITORIES: biostudies-literature

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Depressive symptoms improve over 2 years of type 2 diabetes treatment via a digital continuous remote care intervention focused on carbohydrate restriction.

Adams Rebecca N RN Athinarayanan Shaminie J SJ McKenzie Amy L AL Hallberg Sarah J SJ McCarter James P JP Phinney Stephen D SD Gonzalez Jeffrey S JS

Journal of behavioral medicine 20220127 3

Depressive symptoms are prevalent among people with type 2 diabetes (T2D) and, even at low severity levels, are associated with worse diabetes outcomes. Carbohydrate restriction is an effective treatment for T2D but its long-term impacts on depressive symptoms are unclear. In the current study we explored changes in depressive symptoms over 2 years among 262 primarily non-depressed T2D patients participating in a continuous remote care intervention emphasizing carbohydrate restriction. Subclinic ...[more]

PMID: 35084637

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Project description:BACKGROUND:A growing number of clinical trials use various sensors and smartphone applications to collect data outside of the clinic or hospital, raising the question to what extent patients comply with the unique requirements of remote study protocols. Compliance is particularly important in conditions where patients are motorically and cognitively impaired. Here, we sought to understand patient compliance in digital trials of two such pathologies, Parkinson's disease (PD) and Huntington disease (HD). METHODS:Patient compliance was assessed in two remote, six-month clinical trials of PD (n = 51, Clinician Input Study funded by the Michael J. Fox Foundation for Parkinson's Research) and HD (n = 17, sponsored by Teva Pharmaceuticals). We monitored four compliance metrics specific to remote studies: smartphone app-based medication reporting, app-based symptoms reporting, the duration of smartwatch data streaming except while charging, and the performance of structured motor tasks at home. RESULTS:While compliance over time differed between the PD and HD studies, both studies maintained high compliance levels for their entire six month duration. None (- 1%) to a 30% reduction in compliance rate was registered for HD patients, and a reduction of 34 to 53% was registered for the PD study. Both studies exhibited marked changes in compliance rates during the initial days of enrollment. Interestingly, daily smartwatch data streaming patterns were similar, peaking around noon, dropping sharply in the late evening hours around 8 pm, and having a mean of 8.6 daily streaming hours for the PD study and 10.5 h for the HD study. Individual patients tended to have either high or low compliance across all compliance metrics as measured by pairwise correlation. Encouragingly, predefined schedules and app-based reminders fulfilled their intended effect on the timing of medication intake reporting and performance of structured motor tasks at home. CONCLUSIONS:Our findings suggest that maintaining compliance over long durations is feasible, promote the use of predefined app-based reminders, and highlight the importance of patient selection as highly compliant patients typically have a higher adherence rate across the different aspects of the protocol. Overall, these data can serve as a reference point for the design of upcoming remote digital studies. TRIAL REGISTRATION:Trials described in this study include a sub-study of the Open PRIDE-HD Huntington's disease study (TV7820-CNS-20016), which was registered on July 7th, 2015, sponsored by Teva Pharmaceuticals Ltd., and registered on Clinicaltrials.gov as NCT02494778 and EudraCT as 2015-000904-24 .

Project description:Transcranial direct current stimulation (tDCS) is a brain stimulation technique that can enhance motor activity by stimulating the motor path. Thus, tDCS has the potential of improving the performance of brain-computer interfaces during motor neurorehabilitation. tDCS effects depend on several aspects, including the current density, which usually varies between 0.02 and 0.08 mA/cm2, and the location of the stimulation electrodes. Hence, testing tDCS montages at several current levels would allow the selection of current parameters for improving stimulation outcomes and the comparison of montages. In a previous study, we found that cortico-cerebellar tDCS shows potential of enhancing right-hand motor imagery. In this paper, we aim to evaluate the effects of the focal stimulation of the motor cortex over motor imagery. In particular, the effect of supplying tDCS with a 4 × 1 ring montage, which consists in placing an anode on the motor cortex and four cathodes around it, over motor imagery was assessed with different current densities. Electroencephalographic (EEG) classification into rest or right-hand/feet motor imagery was evaluated on five healthy subjects for two stimulation schemes: applying tDCS for 10 min on the (1) right-hand or (2) feet motor cortex before EEG recording. Accuracy differences related to the tDCS intensity, as well as μ and β band power changes, were tested for each subject and tDCS modality. In addition, a simulation of the electric field induced by the montage was used to describe its effect on the brain. Results show no improvement trends on classification for the evaluated currents, which is in accordance with the observation of variable EEG band power results despite the focused stimulation. The lack of effects is probably related to the underestimation of the current intensity required to apply a particular current density for small electrodes and the relatively short inter-electrode distance. Hence, higher current intensities should be evaluated in the future for this montage.

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Project description:The effect of commercial selection by poultry breeders on the growth, efficiency, and sexual maturity of broiler breeders was studied using 2 University of Alberta Meat Control strains unselected since 1957 and 1978 (AMC-1957 and AMC-1978, respectively) and 2 strains originating from the University of Arkansas; 1995 Random-bred (1995RB) and 2015 Random-bred (2015RB). A study with a 4 × 2 factorial arrangement was conducted with the 4 strains fed at either ad libitum, or restricted levels to achieve a current commercial breeder target BW profile. Growth rate, feed intake, feed efficiency, age at sexual maturity, carcass components, and body conformation were measured. To assess reproductive development, birds were assigned to 2 fates: dissected at photostimulation or dissected after the second oviposition. At 22.4 wk of age, the restricted-fed AMC-1957, AMC-1978, 1995RB, and 2015RB reached 100, 61, 46, and 38% of their ad libitum-fed counterparts' BW, respectively. During the rearing phase, the amount of feed needed to maintain restricted-fed birds on the target BW was 99.4, 57, 29.5, and 24.9% of their ad libitum-fed counterparts for AMC-1957, AMC-1978, 1995RB, and 2015RB, respectively. Feed restricted birds in the 2015RB had lower heat production relative to the AMC-1957 and AMC-1978, which shows that modern strains utilized feed more efficiently compared to the antique strains. This might be related to the increasing severity of feed restriction of broiler breeders over the past 60 years. Relative to AMC-1957 and AMC-1978 strains, the 1995RB and 2015RB strains had heavier breast muscle and lower fat pad weight. Although the pubertal threshold for age and BW have increased over the last 6 decades, changes in selection programs for feed efficiency have resulted in broiler breeders that prioritize nutrient allocation to growth and breast development rather than adipose storage. As a result, feed restricted modern broiler breeders may have marginally sufficient fat resources to support reproduction.

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Depressive symptoms improve over 2 years of type 2 diabetes treatment via a digital continuous remote care intervention focused on carbohydrate restriction.

Publications

Depressive symptoms improve over 2 years of type 2 diabetes treatment via a digital continuous remote care intervention focused on carbohydrate restriction.

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