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Hypertension Canada's 2016 Canadian Hypertension Education Program Guidelines for Blood Pressure Measurement, Diagnosis, Assessment of Risk, Prevention, and Treatment of Hypertension.

Author(s): Leung AA, Nerenberg K, Daskalopoulou SS, McBrien K, Zarnke KB, Dasgupta K, Cloutier L, Gelfer M, Lamarre-Cliche M, Milot A, Bolli P, Trembla...

Can J Cardiol. 2016 05;32(5):569-88 Authors: Leung AA, Nerenberg K, Daskalopoulou SS, McBrien K, Zarnke KB, Dasgupta K, Cloutier L, Gelfer M, Lamarre-Cliche M, Milot A, Bolli P, Tremblay G, McLean...

Article GUID: 27118291
Neighbourhood walkability and home neighbourhood-based physical activity: an observational study of adults with type 2 diabetes.

Author(s): Hajna S, Kestens Y, Daskalopoulou SS, Joseph L, Thierry B, Sherman M, Trudeau L, Rabasa-Lhoret R, Meissner L, Bacon SL, Gauvin L, Ross NA, D...

BMC Public Health. 2016 09 09;16:957 Authors: Hajna S, Kestens Y, Daskalopoulou SS, Joseph L, Thierry B, Sherman M, Trudeau L, Rabasa-Lhoret R, Meissner L, Bacon SL, Gauvin L, Ross NA, Dasgupta K,...

Article GUID: 27613233
Physician step prescription and monitoring to improve ARTERial health (SMARTER): A randomized controlled trial in patients with type 2 diabetes and hypertension.

Author(s): Dasgupta K, Rosenberg E, Joseph L, Cooke AB, Trudeau L, Bacon SL, Chan D, Sherman M, Rabasa-Lhoret R, Daskalopoulou SS, SMARTER Trial Group

Diabetes Obes Metab. 2017 05;19(5):695-704 Authors: Dasgupta K, Rosenberg E, Joseph L, Cooke AB, Trudeau L, Bacon SL, Chan D, Sherman M, Rabasa-Lhoret R, Daskalopoulou SS, SMARTER Trial Group

Article GUID: 28074635
Hypertension Canada's 2017 Guidelines for Diagnosis, Risk Assessment, Prevention, and Treatment of Hypertension in Adults.

Author(s): Leung AA, Daskalopoulou SS, Dasgupta K, McBrien K, Butalia S, Zarnke KB, Nerenberg K, Harris KC, Nakhla M, Cloutier L, Gelfer M, Lamarre-Cli...

Can J Cardiol. 2017 05;33(5):557-576 Authors: Leung AA, Daskalopoulou SS, Dasgupta K, McBrien K, Butalia S, Zarnke KB, Nerenberg K, Harris KC, Nakhla M, Cloutier L, Gelfer M, Lamarre-Cliche M, Mil...

Article GUID: 28449828
Stigma and Its Association With Glycemic Control and Hypoglycemia in Adolescents and Young Adults With Type 1 Diabetes: Cross-Sectional Study.

Author(s): Brazeau AS, Nakhla M, Wright M, Henderson M, Panagiotopoulos C, Pacaud D, Kearns P, Rahme E, Da Costa D, Dasgupta K

J Med Internet Res. 2018 04 20;20(4):e151 Authors: Brazeau AS, Nakhla M, Wright M, Henderson M, Panagiotopoulos C, Pacaud D, Kearns P, Rahme E, Da Costa D, Dasgupta K

Article GUID: 29678801
Title:Physician step prescription and monitoring to improve ARTERial health (SMARTER): A randomized controlled trial in patients with type 2 diabetes and hypertension.
Authors:Dasgupta K,  Rosenberg E,  Joseph L,  Cooke AB,  Trudeau L,  Bacon SL,  Chan D,  Sherman M,  Rabasa-Lhoret R,  Daskalopoulou SS,  SMARTER Trial Group
Link:https://www.ncbi.nlm.nih.gov/pubmed/28074635?dopt=Abstract
Category:Diabetes Obes Metab
PMID:28074635
Dept Affiliation: HKAP
1 Division of Clinical Epidemiology, Department of Medicine, McGill University Health Centre, Montréal, Québec, Canada.
2 Division of Endocrinology, McGill University, Montreal, Québec, Canada.
3 Division of Internal Medicine, Department of Medicine, McGill University, Montreal, Québec, Canada.
4 Department of Family Medicine, St. Mary's Hospital, McGill University, Montreal, Québec, Canada.
5 Divisions of Experimental Medicine and Clinical Epidemiology, Department of Medicine, McGill University Health Centre, Montréal, Québec, Canada.
6 Cardiovascular Prevention Centre, Jewish General Hospital, McGill University, Montreal, Québec, Canada.
7 Division of Exercise Science, Concordia University, Montreal, Québec, Canada.
8 Institut de Recherches Cliniques de Montréal, Université de Montréal, Montreal, Québec, Canada.

Description:

Physician step prescription and monitoring to improve ARTERial health (SMARTER): A randomized controlled trial in patients with type 2 diabetes and hypertension.

Diabetes Obes Metab. 2017 05;19(5):695-704

Authors: Dasgupta K, Rosenberg E, Joseph L, Cooke AB, Trudeau L, Bacon SL, Chan D, Sherman M, Rabasa-Lhoret R, Daskalopoulou SS, SMARTER Trial Group

Abstract

AIMS: There are few proven strategies to enhance physical activity and cardiometabolic profiles in patients with type 2 diabetes and hypertension. We examined the effects of physician-delivered step count prescriptions and monitoring.

METHODS: Participants randomized to the active arm were provided with pedometers and they recorded step counts. Over a 1-year period, their physicians reviewed their records and provided a written step count prescription at each clinic visit. The overall goal was a 3000 steps/day increase over 1 year (individualized rate of increase). Control arm participants were advised to engage in physical activity 30 to 60 min/day. We evaluated effects on step counts, carotid femoral pulse wave velocity (cfPWV, primary) and other cardiometabolic indicators including haemoglobin A1c in diabetes (henceforth abbreviated as A1c) and Homeostasis Model Assessment-Insulin Resistance (HOMA-IR) in participants not receiving insulin therapy.

RESULTS: A total of 79% completed final evaluations (275/347; mean age, 60 years; SD, 11). Over 66% of participants had type 2 diabetes and over 90% had hypertension. There was a net 20% increase in steps/day in active vs control arm participants (1190; 95% CI, 550-1840). Changes in cfPWV were inconclusive; active vs control arm participants with type 2 diabetes experienced a decrease in A1c (-0.38%; 95% CI, -0.69 to -0.06). HOMA-IR also declined in the active arm vs the control arm (ie, assessed in all participants not treated with insulin; -0.96; 95% CI, -1.72 to -0.21).

CONCLUSIONS: A simple physician-delivered step count prescription strategy incorporated into routine clinical practice led to a net 20% increase in step counts; however, this was below the 3000 steps/day targeted increment. While conclusive effects on cfPWV were not observed, there were improvements in both A1c and insulin sensitivity. Future studies will evaluate an amplified intervention to increase impact.

PMID: 28074635 [PubMed - indexed for MEDLINE]