Long-Term Effects of a Novel Continuous Remote Care Intervention Including Nutritional Ketosis for the Management of Type 2 Diabetes A 2-year Non-randomized Clinical Trial, bioRxiv, 2018-11-28

ABSTRACTOBJECTIVEStudies on long-term sustainability of low-carbohydrate approaches to treat diabetes are limited. We aim to assess the effects of a continuous care intervention (CCI) on retention, glycemic control, weight, body composition, cardiovascular, liver, kidney, thyroid, inflammatory markers, diabetes medication usage and disease outcomes at 2 years in adults with type 2 diabetes (T2D).RESEARCH DESIGN AND METHODSAn open label, non-randomized, controlled study with 262 and 87 participants with T2D were enrolled in the CCI and usual care (UC) groups, respectively.RESULTSSignificant changes from baseline to 2 years in the CCI group included HbA1c (−12% from 7.7±0.1%); fasting glucose (−18% from 163.67±3.90 mgdL); fasting insulin (−42% from 27.73±1.26 pmol L-1); weight (−10% from 114.56±0.60 kg); systolic blood pressure (−4% from 131.7±0.9 mmHg); diastolic blood pressure (−4% from 81.8±0.5 mmHg); triglycerides (−22% from 197.2±9.1 mgdL); HDL-C (+19% from 41.8±0.9 mgdL), and liver alanine transaminase (−21% from 29.16±0.97 UL). Spine bone mineral density in the CCI group was unchanged. Glycemic control medication use (excluding metformin) among CCI participants declined (from 56.9% to 26.8%, P=1.3×10-11) including prescribed insulin (−62%) and sulfonylureas (−100%). The UC group had no significant changes in these parameters (except uric acid and anion gap) or diabetes medication use. There was also significant resolution of diabetes (reversal, 53.5%; remission, 17.6%) in the CCI group but not in UC. All the reported improvements had p-values &lt;0.00012.CONCLUSIONSThe CCI sustained long-term beneficial effects on multiple clinical markers of diabetes and cardiometabolic health at 2 years while utilizing less medication. The intervention was also effective in the resolution of diabetes and visceral obesity, with no adverse effect on bone health.TRIAL REGISTRATIONClinicaltrials.gov <jatsext-link xmlnsxlink=httpwww.w3.org1999xlink ext-link-type=clintrialgov xlinkhref=NCT02519309>NCT02519309<jatsext-link>

biorxiv clinical-trials 200-500-users 2018

Climate or disturbance temperate forest structural change and carbon sink potential, bioRxiv, 2018-11-27

ABSTRACTAnticipating forest responses to changing climate and disturbance regimes requires understanding long-term successional processes and aggregating these local processes into global relevance. Estimates of existing forest structure and biomass are improving globally; however, vegetation models continue to show substantial spread in predictions of future land carbon uptake and the roles of forest structural change and demography are increasingly being recognized as important. To identify mechanisms that drive change in tree size, density, and carbon, we need a better understanding of forest structural trajectories and the factors that affect those trajectories. Here we reveal a coherent, cyclic pattern of structural change in temperate forests, as predicted by successional theory, and identify significant sensitivity to climatic precipitation and temperature anomalies using large datasets and empirical modeling. For example, in the eastern US above average temperature (+1°C) was associated with a 27% (−0.4±0.1 Mg C ha-1 yr-1) reduction in productivity attributed to higher rates of disease (+23%), weather disturbance (+57%), and sapling mortality. Projections of future vegetative carbon sink potential suggests biomass would be lowest on managed lands (72±2 Mg C ha-1) and highest when larger trees survive in undisturbed conditions (153±21 Mg C ha-1). Overall, the indirect effects of disturbance and mortality were considerably larger than the direct effects of climate on productivity when predicting future vegetative carbon sinks. Results provide robust comparisons for global vegetation models, and valuable projections for management and carbon mitigation efforts.

biorxiv ecology 0-100-users 2018

 

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