Adding weight management to group visits didn't change HbA1c, but improved weight loss, hypoglycemia

Incorporating intensive weight management with a low-carb diet into standard group medical visits for patients with diabetes “should be considered as an alternative, noninferior approach for glycemic management that has additional clinical advantages,” study authors concluded.


Adding intensive weight management with a low-carbohydrate diet to group medical visits led to similar HbA1c reductions, greater weight loss, and fewer hypoglycemic events for patients with diabetes compared to group visits focused solely on medication optimization, a randomized trial found.

Researchers enrolled 263 outpatients (mean age, 60.7 years; 89.4% men; 54.4% black) with type 2 diabetes, uncontrolled HbA1c, and a body mass index (BMI) of 27 kg/m2 or higher. Participants started attending either standard group medical visits or group visits with intensive weight management between Jan. 12, 2015, and May 30, 2017, at Veterans Affairs Medical Center clinics in Durham and Greenville, N.C., and were followed over 48 weeks.

Participants randomized to standard group medical visits (n=136) received counseling about diabetes-related topics with medication optimization every four weeks for 16 weeks, then every eight weeks, for a total of nine visits. Those randomized to group medical visits combined with intensive weight management (n=127) received low-carbohydrate diet counseling with baseline medication reduction and subsequent medication optimization every two weeks for 16 weeks, followed by an abbreviated group medical visit intervention every eight weeks, for a total of 13 visits. The main outcomes were HbA1c level, hypoglycemic events, diabetes medication effect score, and weight at 48 weeks. Results were published Nov. 4 by JAMA Internal Medicine.

The overall baseline HbA1c level was 9.1%, and baseline BMI was 35.3 kg/m2. At 48 weeks, HbA1c level improved in both study arms (8.2% in the intensive weight management arm and 8.3% in the standard arm; mean difference, −0.1% [95% CI, −0.5% to 0.2%]; P=0.44). However, at 48 weeks, the intensive weight management arm had lower diabetes medication use (mean difference in medication effect score, −0.5 [95% CI, −0.6 to −0.3]; P<0.001) and greater weight loss (mean difference, −3.7 kg [95% CI, −5.5 to −1.9 kg]; P<0.001) compared to the standard arm. Participants in the intensive weight management arm also had about 50% fewer hypoglycemic events than those in the standard arm (incidence rate ratio, 0.49 [95% CI, 0.27 to 0.71]; P<0.001) during the 48-week period.

The study was limited by the different frequency of meetings in the two arms and the fact that study physicians could not be blinded to the study arms, the authors noted. They concluded that when group medical visits are used for patients with diabetes, visits that incorporate intensive weight management “should be considered as an alternative, noninferior approach for glycemic management that has additional clinical advantages.”