By: Ed Susman
SAN DIEGO, CA – A multidisciplinary, clinical, team-led intensive, lifestyle-intervention program among patients with type 2 diabetes appears to maintain the benefits seen in 12 weeks for at least as long as 3 years, researchers stated at the American Diabetes Association 71st Scientific Sessions.
Patients who had a mean glycosylated haemoglobin A1C (Hb A1C) of 7.6% at baseline were able to lower the Hb A1C to 6.6% after 12 weeks (P <.001) of the intensive program and were still at 7% after 3 years, also a significant reduction from baseline (P <.01).
“Lifestyle intervention can be accomplished in clinical practice,” said Osama Hamdy, MD, Joslin Clinic, and Harvard Medical School, Boston, Massachusetts.
Dr. Hamdy said the Weight Achievement and Intensive Treatment program (WAIT) has been incorporated into regular practice at the Joslin Clinic.
The researchers enrolled 141 patients with diabetes -- 127 with type 2 diabetes and 14 patients with type 1 diabetes. The patients had a mean age of 53.3 years and had been diagnosed with diabetes for about 9.5 years. Ninety-one of the patients were women. The average weight of the participants was 108.86 kg (240 lbs).
Six of the patients dropped out of the study before completing 12 weeks, Dr. Hamdy noted. He reported on 135 patients who completed 2 years of follow-up (105 had completed 2.5 years and 70 patients had completed 3 years of follow-up).
The interdisciplinary team included a diabetologist, a registered dietician, a clinical exercise physiologist, and a psychologist. Changes in medication were made with special emphasis on weight-neutral or weight-negative medications.
The dietary intervention gave patients a choice of 15 dinner meals, 2 meal replacements, and snacks designed to meet the Joslin Clinics nutritional guidelines for diabetics — a diet plan that included 40% to 45% carbohydrates, 20% to 30% protein, and <35% fat. “The menus were designed by a registered dietician to be low in glycaemic index, high in fiber, and low in saturated fat,” Dr. Hamdy explained.
The researchers also put the patients through a structured strength and cardiovascular exercise program that gradually increased activity. For the first 4 sessions, patients were encouraged to exercise 20 to 40 minutes 4 days a week; during the next 4 sessions, the exercise prescription was increased to 40 to 45 minutes 5 days a week; and in the final 4 sessions, patients were told to exercise 50 to 60 minutes 6 days a week.
The patients also attended weekly teaching and behavioural support sessions. At the end of the program, participants were instructed to follow the same plan on their own.
The average weight loss after 12 weeks of the study was 10.9 kg (24.1 lbs). Weight loss averaged 8.26 kg (18.2 lbs) at 1 year; 8.53 kg (18.8 lbs) at 2 years; and 7.8 kg (17.2 lbs) at 2.5 and 3 years.
The patient change in Hb A1C decreased from 7.6% to 6.6% after 12 weeks; was 7% after 1 year; was 6.9% at 2 years; 7% at 2.5 years; and 7% at 3 years. Approximately 82% of patients achieved the goal of 7% after 12 weeks, but that percentage declined to 47% of patients at 2 years, 43% of patients at 2.5 years, and 40% of patients at 3 years.
- MFP Wire Services