Clinic-Based Support to Help Overweight Patients With Type 2 Diabetes Increase Physical Activity and Lose Weight

Abstract

A brief intervention to increase the dialogue between patients and health care providers about behavioral goals can lead to increased physical activity and weight loss.

How can clinical practices pragmatically increase physical activity for patients with type 2 diabetes? A systematic review

“…This suggests that PA interventions conducted in more real-world settings may be less effective when compared to studies in more idealized and heavily resourced contexts. Nevertheless, among the behavioral interventions that we ranked in the most pragmatic tertile by composite PRECIS-2 scores, four interventions by SperlHillen et al [39], Christian et al [50], Di Loreto et al [53], and Glasgow et al [54] effectively improved PA outcomes-two of these four effective PA interventions also improved HbA1c outcomes [31,45].…”

“…These tools included a simplified form of in-person motivational interviewing [53], a computerized self-assessment that automatically generated individualized and tailored feedback [50,54], or the use of a Bconversation map^of diabetes self-management challenges [39]. While we already know much about what factors are necessary for effective interventions, we need to better understand how to ensure that these techniques are effective when delivered pragmatically in clinical settings.…”

“…Diabetes researchers have also been encouraged by the promise of eHealth to enhance the reach and effectiveness of T2D self-management interventions, including PA interventions [78,79]. Thus, we were intrigued to notice that only 6 of the 46 interventions that we studied utilized any measures related to eHealth [50,54,55,64,80]. However, it is important to note that most of the interventions we studied were conducted before the recent explosion of smartphone and wearable technology for tracking PA [81,82]; in the coming years, these percentages may change considerably as more researchers begin to embrace eHealth.…”

“…This is a limitation, as it would be more challenging for clinics without a population health team to implement interventions that rely on staff contact outside of faceto-face clinician visits. However, two of the effective interventions in the top tier of pragmatism would be pragmatic to deliver in standard primary care clinics, as well as PCMH models, as they did not rely on a population health team for intervention delivery [50,53]. Finally, we only assessed interventions that were clinically integrated; a prior review has identified important strategies for partnership between clinics and community organizations to improve diabetes selfmanagement [29], and future research should identify pragmatic and effective interventions that can be delivered in partnership with community organizations.…”

Computer-Based Interventions to Improve Self-management in Adults With Type 2 Diabetes: A Systematic Review and Meta-analysis

“…One only included women (12). Participants in one study (14) were all Latin or Hispanic. Three studies (13,15,16) reported that .70% of participants were Caucasian or non-Hispanic white.…”