Diabetes interventions show promise in primary care

Dec 28 2012

By medwireNews Reporters

Two lifestyle-based diabetes interventions developed in a clinical trial could successfully promote weight loss in primary care, research shows.

The lifestyle interventions, adapted from the Diabetes Prevention Program (DPP), resulted in reductions in body mass index (BMI), ranging from 1.6 to 2.2 kg/m².

"Proven effective in a primary care setting, the two DPP-based lifestyle interventions are readily scalable and exportable with potential for substantial clinical and public health impact," state Jun Ma (Palo Alto Medical Foundation Research Institute, California, USA) and colleagues in the Archives of Internal Medicine.

Given the obesity epidemic and growing numbers of US individuals with diabetes, the successful adaption of these proven DPP interventions in primary care is of critical importance, say the researchers.

The study, known as the Evaluation of Lifestyle Interventions to Treat Elevated Cardiometabolic Risk in Primary Care (E-LITE), evaluated the effectiveness of the adapted DPP lifestyle interventions in patients with prediabetes and/or the metabolic syndrome.

In total, 79 patients were randomly assigned to a coach-led intervention, 81 patients were assigned to a self-directed DVD intervention, and 81 patients were assigned to usual care.

Following a 3-month intensive intervention phase, the maintenance phase of the program allowed participants in the intervention groups to access remote support and coaching through email, and the American Heart Association's Heart360 website.

The average BMI at baseline was 32.0 kg/m². By 15 months, BMI had decreased by a mean of 2.2 kg/m² in the coach-led group and by 1.6 kg/m² in the DVD-based group; both changes were statistically significant compared with the 0.9 kg/m² reduction in the usual care group.

Overall, a respective 37.0% and 35.9% of participants in the coach-led and DVD-based DPP interventions achieved at least a 7.0% reduction in weight loss.

These proportions were statistically significant when compared with the 14.4% of participants in the usual care group who achieved at least a 7.0% reduction.

Additionally, the DPP interventions both resulted in significant improvements in waist circumference and fasting plasma glucose levels.

Ma and co-workers acknowledge that the DPP interventions are not new, but that their successful integration into primary care is novel. "The E-LITE trial makes a unique contribution to this growing literature in that its interventions integrate standardized, packaged DPP translational programs (delivered in groups or by DVD) with existing health IT [information technology]," conclude the authors.

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