Improving diabetes outcomes through lifestyle change – A randomized controlled trial

Abstract

Objective: To compare a diabetes group lifestyle intervention (GLI) with dietitian referral for medical nutrition therapy (RD) for weight loss in the usual care setting. Methods: Randomized clinical trial was conducted with 57 primary care patients with type 2 diabetes and body mass index (BMI) >25 kg/m 2 who received either a dietitian-led 19-week GLI adapted from the Look AHEAD study or RD. Outcome measures include 6-month and 1-year weight loss, changes in medications, glycemic control, cardiac risk factors, and cost analysis. Results: Patients were mean age 61, 59% male, and 32% non-white, and they weighed 97 kg with mean HbA1c 8.2%. At 6 months, 46% of GLI vs. 21% of RD lost 5% body weight (P 5 0.04), with mean weight loss 6.6 (SD 7.0) kg with GLI and 2.1 (3.5) kg in RD (P 5 0.004). HbA1c improved by 0.70 (1.13) vs. 0.39 (1.51) in GLI vs. RD (P 5 0.4), respectively, and 82% vs. 38% stopped or reduced diabetes medications (P < 0.001). Weight loss remained significantly greater in GLI compared to RD at 1 year. GLI program cost was $578 per participant.Conclusions: An affordable GLI achieved significantly more weight loss and medication reduction than RD in primary care patients with type 2 diabetes.

Educational weight loss interventions in obese and overweight adults with type 2 diabetes: a systematic review and meta‐analysis of randomized controlled trials

“…Five trials [31,32,36,39,S18] selected participants after a run-in phase lasting between 3 days [36] and 6 months [S18] during which time participants confirmed their commitment by activities such as completing food and exercise diaries, or attending regular diabetes education sessions.…”

“…All five trials providing extra contacts with intervention staff, if required, saw significant effects on weight [38,40,45,S14,S19]. Eight of the nine trials providing personalized feedback showed significant effects on weight/BMI [28,32,39,42,45,S4,S15, S19].…”

“…There were seven trials. Six from the USA [29,32,34,39,40,50] and one from the UK [7]. Sample sizes ranged from 49 [7] to 5145 [39].…”

Why young women gain weight: A narrative review of influencing factors and possible solutions

“…Greater success with maintaining a lower weight after significant weight loss (“secondary weight maintenance”) is possible via intensive and costly interventions including long‐term behavioural support . There is a need to research programmes that maintain success with lower financial expense . Importantly, research must also focus on “primary weight maintenance, ” that is, strategies to avoid weight gain and remain a healthy weight throughout life.…”

Translating the look AHEAD trial into action

“…It is against this backdrop that we view the impressive work of Delahanty and colleagues to adapt the Look AHEAD intensive lifestyle intervention (ILI) for the primary care setting. The ILI demonstrated significant weight loss of 8.6% and cardiovascular risk factor improvement at 1 year among individuals with obesity and type 2 diabetes (T2D) .…”