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Background: Adult smoking rates in the USA are highest in economically depressed rural Appalachia. Pharmacist-delivered tobacco cessation support that incorporates medication therapy management (such as the QuitAid intervention) is a promising approach to address this need. Methods: Twenty-four adult smokers recruited between September and November 2021 through an independent pharmacy in rural Appalachia were randomized in a non-blinded 2 × 2 × 2 factorial design to (1) pharmacist delivered QuitAid intervention (yes vs. no); (2) combination nicotine replacement therapy (NRT) gum + NRT patch (vs. NRT patch); and/or (3) 8 weeks of NRT (vs. standard 4 weeks). Participants received 4 weeks of NRT patch in addition to the components to which they were assigned. Participants completed baseline and 3-month follow-up assessments. Primary outcomes were feasibility of recruitment and randomization, retention, treatment adherence, and fidelity. Results: Participants were recruited in 7 weeks primarily through a referral process, commonly referred to as ask-advise-connect (61%). Participants were on average 52.4 years old, 29.2% were male and the majority were white (91.6%) and Non-Hispanic (91.7%). There was a high level of adherence to the interventions, with 85% of QuitAid sessions completed, 83.3% of the patch used, and 54.5% of gum used. Participants reported a high level of satisfaction with the program, and there was a high level of retention (92%). Conclusions: This demonstration pilot randomized controlled study indicates that an ask-advise-connect model for connecting rural smokers to smoking cessation support and providing QuitAid for smoking cessation is feasible and acceptable among rural Appalachian smokers and independent pharmacists. Further investigation into the efficacy of a pharmacist-delivered approach for smoking cessation is needed. Trial registration: The trial was retrospectively registered at ClinicalTrials.gov. Trial #: NCT05649241. [ABSTRACT FROM AUTHOR]

Background: Residency training requires work in clinical settings for extended periods of time, resulting in altered sleep patterns, sleep deprivation, and potentially deleterious effects on safe performance of daily activities, including driving a motor vehicle.Methods: Twenty-nine anesthesiology resident physicians in postgraduate year 2 to 4 drove for 55 min in the Virginia Driving Safety Laboratory using the Driver Guidance System (MBFARR, LLC, USA). Two driving simulator sessions were conducted, one experimental session immediately after the final shift of six consecutive night shifts and one control session at the beginning of a normal day shift (not after call). Both sessions were conducted at 8:00 AM. Psychomotor vigilance task testing was employed to evaluate reaction time and lapses in attention.Results: After six consecutive night shifts, residents experienced significantly impaired control of all the driving variables including speed, lane position, throttle, and steering. They were also more likely to be involved in collisions. After six consecutive night shifts, residents had a significant increase in reaction times (281.1 vs. 298.5 ms; P = 0.001) and had a significant increase in the number of both minor (0.85 vs. 1.88; P = 0.01) and major lapses (0.00 vs. 0.31; P = 0.008) in attention.Conclusions: Resident physicians have greater difficulty controlling speed and driving performance in the driving simulator after six consecutive night shifts. Reaction times are also increased with emphasis on increases in minor and major lapses in attention after six consecutive night shifts. [ABSTRACT FROM AUTHOR]

In a recent randomized clinical trial, we compared 6 hours of conventional weight loss (WL) training to an equivalent amount of Glycemic Excursion Minimization (GEM) that is a paradigm-shift in lifestyle management for adults with T2D. GEM focuses on diminishing post-nutrient BG excursions by: 1) minimizing BG upsurge by reducing net carbohydrate ingestion, and 2) hastening BG recovery by increasing routine and post-meal physical activity.1 We now present the 13-month follow-up data, with no further training or contact, to evaluate the relative durability of these interventions. All of the WL and 97% of GEM participants who completed 3-month post-assessment also completed 13-month follow-up. At 13 months, WL participants sustained the improvement in BMI they showed at 3 months, while GEM participants continued to significantly benefit from lower HbA1c (p<.001), diabetes medication usage, cardiovascular risk, BMI, HDL, and improved psychological function regarding empowerment and diabetes distress (p's <.01). Fifty-two percent of GEM participants were classified as Responders (mean HbA1c reduction of -1.5%). Being a GEM Responder at 13 months was unrelated to demographic or disease severity variables. Regression analyses indicated being a GEM long-term Responder was preceded by short-term post-treatment reduction of HbA1c, BMI and diabetes medication, correctly classifying 76% of eventual Responders and Non-responders. WL Responders could not be identified. Our data suggest GEM is a sustainable treatment option in the management of T2D. 1BMJ Open Diabetes Research & Care, 8:e001795. doi: 10.1136/bmjdrc-2020-001795. Disclosure: D. Cox: Research Support; Self; Abbott Diabetes, Dexcom, Inc. M. A. Moncrief: Research Support; Self; Abbott Diabetes, Dexcom, Inc. A. L. Mccall: None. Funding: National Institutes of Health (DK108957) [ABSTRACT FROM AUTHOR]

Carbohydrate (carb) ingestion strongly influences postprandial glucose (PPG). With recent interest in the role PPG plays in A1c and diabetic complications, there are research and clinical needs to quantify routine carb consumption. The 24-hour dietary recall is the gold standard for estimating carbs eaten, but it is tedious and narrowly focused. We developed a simple self-report to measure carbs routinely consumed (CRC). We hypothesized that the CRC would: 1) be reliable, 2) correlate with the 24-hour dietary recall, 3) be sensitive to a PPG-lowering intervention, and 4) reflect changes in A1c. Adults with type 2 diabetes (n = 116; mean age: 56 ± 11.6 years; mean disease duration: 5.3 ± 3 years; mean A1c: 8.2 ± 1.0) participated in a clinical trial comparing weight reduction to PPG reduction. At baseline and 3-month follow-up, participants completed the CRC, 3 days of ASA24 dietary recall, and A1c. The CRC score was the sum of the number of servings of 16 different high-carb food classes eaten (e.g., dried fruits) in an average week. The CRC mean was 35.9 ± 16.1. One-week test-retest reliability (r) was.96 (p =.02). Validity: At baseline, carbs eaten by CRC and ASA24 dietary recall were correlated (r =.43, p <.001). Change in CRC from baseline to follow-up was significantly lower for the PPG group (36.8 to 20.3, p <.001) but not for the weight-lowering group (33.0 to 34.4, p =.7). Correlation of pre-post change in A1c with CRC and ASA24 were r =.39 (p =.002) and r = -.03 (p =.8) respectively. Regression analysis indicated only the change in CRC predicted change in A1c. These data indicate the CRC is reliable and shows concurrent, discriminant and predictive validity - only changes in CRC reflected changes in A1c. The CRC may be useful to researchers in evaluating programs designed to lower carb intake. Clinicians might use it to evaluate a patient's routine consumption of carbs and responsiveness to lifestyle interventions. Limitation: the CRC is not a comprehensive nutritional analysis. Disclosure: D. Cox: None. M.A. Moncrief: None. T. Banton: None. V.M. Ngo: None. H. Singh: None. A.M. Diamond: None. A.L. McCall: None. Funding: National Institutes of Health (R01DK108957); Dexcom, Inc. (IIS-2016-047) [ABSTRACT FROM AUTHOR]

The article discusses continuous glucose monitoring in the self-management of type 2 diabetes. It mentions the feasibility and efficacy of replacing systematic self-monitoring of blood glucose. It notes that those who monitored glucose with continuous glucose monitoring reported eating more low glycemic load foods.

Background: Weight loss (WL) is the initial treatment of choice for adults with t2d, but it is inappropriate for lean patients, unwanted/unsuccessful for some obese individuals, and unsustainable for others. An alternative is needed. Aim: Because post-prandial glucose (PPG) contributes strongly to A1c, we tested if a treatment focused on reducing PPG by reducing carbohydrate intake and increasing physical activity (Glycemic Excursion Minimization - GEM) would be equal or superior to WL for improving A1c and secondary benefits. We also hypothesized GEM would be enhanced by the quality and quantity of blood glucose (BG) feedback. Methods: Generally healthy adults (t2d ≤ 10 years, not on insulin, A1c ≥ 6.8) were randomized to WL (n = 36) or one of 3 GEM subgroups: 1) Didactic (GEMD, n = 35) taught participants how to choose low glycemic load foods, reduce sedentary time and increase moderate routine physical activity, 2) Didactic + systematic BG monitoring (GEMS, n =48) before and after meals and physical activity to educate, activate and motivate food and activity choices, or 3) Didactic + continuous glucose monitoring (GEMC, n = 43). WL treatment was led by diabetes nutritionists and followed the CDC Prevent T2 weight loss manual. GEM treatment was led by a diabetes nurse educator. All subjects received 6 hours of training, BG meters and wore activity monitors. A1c, weight, UKPDS, DDS, DES and PHQ-9 were assessed pre and 3 months post treatment. Results: The GEM subgroups did not differ, so they were combined. Both WL and GEM significantly reduced weight and diabetes distress (regimen). Only GEM significantly improved A1c (8.3 to 7.3, p <.001), cardiovascular risk (p <.001), empowerment (p <.001), and diabetes distress (emotional, p <.02). Discussion: Lifestyle interventions focused on minimizing PPG by reducing carbohydrates and increasing routine physical activity are effective alternatives to WL. Adding BG monitoring did not significantly enhance GEM's effectiveness. Disclosure: D. Cox: Research Support; Self; Dexcom, Inc. T. Banton: Research Support; Self; Dexcom, Inc. M.A. Moncrief: Research Support; Self; Dexcom, Inc. A. Diamond: Research Support; Self; Dexcom, Inc. V. Holmes: None. A. Wolf: None. K. Fang: None. A.L. McCall: None. Funding: Dexcom, Inc. (IIS-2017-047); National Institutes of Health (R01DK108957) [ABSTRACT FROM AUTHOR]

Introduction: Efforts to lower glycosylated hemoglobin (A1c) in patients with type 2 diabetes (T2D) are intended to reduce the risk of diabetic complications, but A1c is not the only factor contributing to this risk. Consequently, we re-analyzed published data from a broad-spectrum lifestyle intervention that lowered A1c to assess its effectiveness in lowering the overall risk of two complications of T2D, namely, coronary heart disease (CHD) and stroke.Methods: Data from 37 adults who participated in a randomized clinical trial of a lifestyle intervention intended to reduce postprandial glucose (PPG) were re-analyzed for their pre- and post-treatment risk of CHD and stroke using the T2D-specific UK Prospective Diabetes Study (UKPDS) v2.0 risk algorithm.Results: Compared to participants who received routine care, those using the lifestyle intervention had a significantly greater reduction in 10-year risk for CHD, but not for stroke.Conclusion: These secondary analyses suggest that broad-spectrum lifestyle interventions that focus on lowering PPG may lower the risk of future CHD, which could guide future research.Trial Registration: ClinicalTrials.gov ID: NCT02432391. [ABSTRACT FROM AUTHOR]

For some individuals with autism spectrum disorder, driving apprehension may interfere with the acquisition and application of driving privileges. The Driving Attitude Scale Parent-Report provides an indication of novice drivers’ positive and negative attitudes toward driving. Responses were compared for parents of 66 autism spectrum disorder and 166 neuro-typical novice drivers. After the autism spectrum disorder drivers completed 3 months of driver training, 60 parents repeated the Driving Attitude Scale Parent-Report. Parents reported autism spectrum disorder drivers to have less positive and more negative attitudes toward driving than parents of neuro-typical drivers. Parents of autism spectrum disorder drivers who received driving training in a safe/low-threat virtual reality driving simulator demonstrated a significant increase in positive attitudes and reduction in negative attitudes, compared to parents of autism spectrum disorder drivers undergoing routine driver training. The reports of parents of autism spectrum disorder drivers suggest potential problems with learning to drive that can go beyond general abilities and include driving apprehension. [ABSTRACT FROM AUTHOR]

Investigate how novice drivers with autism spectrum disorder (ASD) differ from experienced drivers and whether virtual reality driving simulation training (VRDST) improves ASD driving performance. 51 novice ASD drivers (mean age 17.96 years, 78% male) were randomized to routine training (RT) or one of three types of VRDST (8-12 sessions). All participants followed DMV behind-the-wheel training guidelines for earning a driver's license. Participants were assessed pre- and post-training for driving-specific executive function (EF) abilities and tactical driving skills. ASD drivers showed worse baseline EF and driving skills than experienced drivers. At post-assessment, VRDST significantly improved driving and EF performance over RT. This study demonstrated feasibility and potential efficacy of VRDST for novice ASD drivers. [ABSTRACT FROM AUTHOR]

Previous studies have shown that individuals with autism spectrum disorder (ASD) demonstrate poorer driving performance than their peers and are less likely to obtain a driver's license. This study aims to examine the relationship between driving performance and executive functioning for novice drivers, with and without ASD, using a driving simulator. Forty-four males (ages 15-23), 17 with ASD and 27 healthy controls, completed paradigms assessing driving skills and executive functioning. ASD drivers demonstrated poorer driving performance overall and the addition of a working memory task resulted in a significant decrement in their performance relative to control drivers. Results suggest that working memory may be a key mechanism underlying difficulties demonstrated by ASD drivers and provides insight for future intervention programs. [ABSTRACT FROM AUTHOR]

Aims: This preliminary RCT investigated whether an integrated lifestyle modification program that focuses on reducing postprandial blood glucose through replacing high with low glycemic load foods and increasing routine physical activities guided by systematic self-monitoring of blood glucose (GEM) could improve metabolic control of adults with type 2 diabetes mellitus, without compromising other physiological parameters.Methods: Forty-seven adults (mean age 55.3 years) who were diagnosed with type 2 diabetes mellitus for less than 5 years (mean 2.1 years), had HbA1c ≥ 7% (mean 8.4%) and were not taking blood glucose lowering medications, were randomized to routine care or five 1-h instructional sessions of GEM. Assessments at baseline and 6 months included a physical exam, metabolic and lipid panels, and psychological questionnaires.Results: The GEM intervention led to significant improvements in HbA1c (decreasing from 8.4 to 7.4% [69-57 mmol/mol] compared with 8.3 to 8.3% [68-68 mmol/mol] for routine care; Interaction p<.01) and psychological functioning without compromising other physiological parameters.Conclusions: Consistent with a patient-centered approach, GEM appears to be an effective lifestyle modification option for adults recently diagnosed with type 2 diabetes mellitus. [ABSTRACT FROM AUTHOR]