OBJECTIVE -We sought to determine whether adding motivational interviewing to a behavioral weight control program improves weight loss outcomes and glycemic control for overweight women with type 2 diabetes.RESEARCH DESIGN AND METHODS -We conducted a randomized, controlled, clinical trial in which participants all received an 18-month, group-based behavioral obesity treatment and were randomized to individual sessions of motivational interviewing or attention control (total of five sessions) as an adjunct to the weight control program. Overweight women with type 2 diabetes treated by oral medications who could walk for exercise were eligible. Primary outcomes were weight and A1C, assessed at 0, 6, 12, and 18 months.RESULTS -A total of 217 overweight women (38% African American) were randomized (93% retention rate). Women in motivational interviewing lost significantly more weight at 6 months (P ϭ 0.01) and 18 months (P ϭ 0.04). Increased weight losses with motivational interviewing were mediated by enhanced adherence to the behavioral weight control program. African-American women lost less weight than white women overall and appeared to have a diminished benefit from the addition of motivational interviewing. Significantly greater A1C reductions were observed in those undergoing motivational interviewing at 6 months (P ϭ 0.02) but not at 18 months.CONCLUSIONS -Motivational interviewing can be a beneficial adjunct to behavioral obesity treatment for women with type 2 diabetes, although the benefits may not be sustained among African-American women. Diabetes Care 30:1081-1087, 2007I ndividuals with type 2 diabetes frequently are overweight (1-3) and experience a range of obesity-related comorbidities (4). With every unit increase in BMI, direct medical costs associated with type 2 diabetes significantly increase (5). Weight loss has been shown to improve metabolic control and other health parameters among individuals with type 2 diabetes (6,7), with greater weight loss producing greater improvements in metabolic functioning (8). However, sustained weight loss can be challenging (9), particularly for individuals with diabetes (10). African-American women experience particular difficulties in achieving weight loss (11,12), a matter of concern given high rates of obesity (13) and diabetes (14) in this group. Therefore, improving obesity treatment outcomes for overweight individuals with comorbid diabetes has been identified as a research priority (15).Motivational interviewing (16) is a brief intervention approach demonstrated to promote better long-term outcomes for a range of health outcomes (17,18), with preliminary support as an adjunct to behavioral obesity treatment. Motivational interviewing produced significantly better glycemic control and treatment adherence and a trend toward greater short-term weight loss in a pilot study of overweight diabetic women (19). Furthermore, motivational interviewing interventions have been shown to be effective in promoting changes in diet and physical activity (20 -22). Desp...

We found lower rates of smoking cessation advice among ethnic minorities. However, we also found complex interactions of ethnicity with socioeconomic factors.

These data validate gaps in primary care practices in obtaining family history of cancer, as well as lack of confidence in explaining genetic test results and in tailoring recommendations based on the tests.

The Medication Event Monitoring System (MEMS), an electronic monitor which records the date and time of bottle cap openings, and pill counts were used to assess patterns of adherence for the primary antihypertensive drug in the African American Study of Kidney Disease and Hypertension Pilot Study (AASK). Blacks with hypertension and moderately reduced renal function were randomized to one of two levels of blood pressure control and to one of three antihypertensive drug regimens: primary therapy with a calcium channel blocker, an angiotension converting enzyme inhibitor, or a beta-blocker. Of the 94 participants in AASK, 91 had MEMS recordings and pill counts for 313 regularly scheduled monthly follow-up visits. The average length of follow-up was 4.6 months. An acceptable level of adherence by pill count was achieved if 80% to 100% of the prescribed pills were not returned to the clinic. Adherence by MEMS to a once-a-day drug dosing schedule was acceptable if 80% of the time intervals between MEMS openings were within 24 +/- 6 h. Acceptable adherence by pill count was observed at 68% of the follow-up visits; MEMS indicated nonadherence at 47% of those visits. Blood pressure was within goal in 50% of the participants who were adherent by both pill count and MEMS throughout their follow-up visits, and only 14% of the participants who were identified nonadherent by one or both methods. These findings suggest that electronic monitoring is a useful adjunct to pill counts in assessing adherence to antihypertensive drugs. Feedback of electronically collected information on dosing intervals to participants and staff may enhance adherence.