Jacqueline Shahar | Massachusetts College of Pharmacy and Health Sciences (original) (raw)

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Papers by Jacqueline Shahar

Frontiers in Endocrinology, Jan 17, 2023

Diabetes

A 12-week multidisciplinary intensive lifestyle intervention (ILI) was shown to induce diabetes r... more A 12-week multidisciplinary intensive lifestyle intervention (ILI) was shown to induce diabetes remission (A1C <6.5%, on no medications for ≥3 months), particularly among participants with short diabetes duration. Diabetes remission was also achieved with very low-calorie diet (VLCD) or bariatric surgery. Diabetes Remission Outcomes Protocol (DROP) at Joslin Diabetes Center is an ILI designed to induce diabetes remission in patients with type 2 diabetes who meet 3 criteria: 1- duration of diabetes <5 years, 2- A1C <8%, 3- On up to 2 antihyperglycemic medications, but no insulin. It involves two phases: an intervention phase for 12 weeks and a maintenance phase for 9 months. During intervention phase, participants follow a time-restricted fasting for 16 hours and VLCD (800-1000 Kcal/day). Participants also receive cognitive behavioral support and perform exercises designed to maintain lean muscle mass (LMM). They stop all diabetes medications at the beginning of the program ...

Current Developments in Nutrition

Objectives The Weight Achievement and Intensive Treatment (Why WAIT) program is a 12-week multidi... more Objectives The Weight Achievement and Intensive Treatment (Why WAIT) program is a 12-week multidisciplinary intensive lifestyle intervention (ILI) program for diabetes and weight management. We previously showed that the in-person model (iPM) of ILI has led to long-term maintenance of 6.9% weight loss for up to 10 yrs in real-world clinical practice. With the advent of the COVID-19 pandemic, we reported that a totally virtual model (VM) of the ILI program for the same duration was equally effective in reducing body weight and improving glycemic control. In this study, we test a newly introduced hybrid model (HM), combining 2 in-person sessions with 10 virtual sessions, to accommodate the prolonged restrictions of an ongoing pandemic. Methods We evaluated 46 participants (age 57 ± 11 yrs; 52% females, 30% with type 1 diabetes) who enrolled in HM (n = 8; A1C 6.79 ± 0.97%; BMI 32.7 ± 6.7 kg/m2), VM (n = 16; A1C 7.73 ± 1.32%; BMI 33.5 ± 6.4 kg/m2) and iPM (n = 22; A1C 7.98 ± 1.09%; BMI ...

Therapeutic Advances in Endocrinology and Metabolism

Background: Intensive lifestyle intervention (ILI) is essential for diabetes management. The Weig... more Background: Intensive lifestyle intervention (ILI) is essential for diabetes management. The Weight Achievement and Intensive Treatment (Why WAIT) program is a 12-week multidisciplinary weight management program that has been implemented in real-world clinical practice since 2005 and has shown long-term maintenance of weight reduction for 5 and 10 years. During the COVID-19 pandemic, the program went virtual using telemedicine and mobile health applications. Aims: This retrospective pilot study aims to evaluate the effectiveness of a virtual model of an already established and successful in-person program for diabetes and weight management since 2005. Methods: We evaluated 38 patients with diabetes and obesity enrolled in the Why WAIT program between February 2019 and December 2020. Sixteen participants were enrolled in virtual program (VP) and were compared with 22 participants who completed the latest two physical programs (PPs) before COVID-19. We evaluated changes in body weight...

Diabetes Care, 2018

OBJECTIVE Patients with type 1 diabetes who do aerobic exercise often experience a drop in blood ... more OBJECTIVE Patients with type 1 diabetes who do aerobic exercise often experience a drop in blood glucose concentration that can result in hypoglycemia. Current approaches to prevent exercise-induced hypoglycemia include reduction in insulin dose or ingestion of carbohydrates, but these strategies may still result in hypoglycemia or hyperglycemia. We sought to determine whether mini-dose glucagon (MDG) given subcutaneously before exercise could prevent subsequent glucose lowering and to compare the glycemic response to current approaches for mitigating exercise-associated hypoglycemia. RESEARCH DESIGN AND METHODS We conducted a four-session, randomized crossover trial involving 15 adults with type 1 diabetes treated with continuous subcutaneous insulin infusion who exercised fasting in the morning at ∼55% VO2max for 45 min under conditions of no intervention (control), 50% basal insulin reduction, 40-g oral glucose tablets, or 150-μg subcutaneous glucagon (MDG). RESULTS During exerci...

Educating Your Patient with Diabetes

Behavioral approaches to weight loss and diabetes management have been studied for decades. Effec... more Behavioral approaches to weight loss and diabetes management have been studied for decades. Effective lifestyle programs successfully combine three primary interventions – dietary changes, increased physical activity, and behavioral weight loss strategies. The goal of such a multi-pronged approach is to teach patients the skills they need to maintain a balanced meal plan, a long-term exercise program, and integrate these

Medicine & Science in Sports & Exercise, 2007

Diabetes spectrum : a publication of the American Diabetes Association, 2015

BMJ open diabetes research & care, 2017

We evaluated long-term impact of sustained weight loss versus weight regain on cardiovascular ris... more We evaluated long-term impact of sustained weight loss versus weight regain on cardiovascular risk factors in real-world clinical practice. We evaluated 129 obese patients with diabetes enrolled in Weight Achievement and Intensive Treatment (Why WAIT) program, a 12-week clinical model of intensive lifestyle intervention. After 1 year, we divided participants into group A, who maintained <7% weight loss (47.3%) and group B (52.7%), who maintained ≥7% weight loss. We continued to follow them for a total of 5 years. The total cohort lost 23.8 lbs (-9.7%) at 12 weeks and maintained -16.2 lbs (-6.4%) at 5 years (p<0.001). Group A maintained -8.4 lbs (-3.5%) and group B maintained -23.1 lbs (-9.0%) at 5 years. In group A, A1C decreased from 7.5±1.3% to 6.7±0.9% at 12 weeks but increased to 7.7±1.4% at 1 year and 8.0±1.9% at 5 years. In group B, A1C decreased from 7.4±1.2% to 6.4±0.9% at 12 weeks and rose to 6.8±1.2% at 1 year and 7.3±1.5% at 5 years. Despite weight regain, group A m...