Primary care patients drop weight, waist size with lifestyle intervention treatments

Primary care patients in two different diabetes-prevention treatment groups lost weight, reduced waist circumference and lowered blood glucose levels, compared with a usual care group.

Researchers adapted two lifestyle interventions from the Diabetes Prevention Program (DPP), which had previously shown success in clinical trials, to a primary care setting. Patients (n=241) were recruited between July 2009 and June 2010 from a clinic in Los Altos, Calif. They were at least 18 years old, had a body mass index (BMI) of 25 kg/m² or more, and had either pre-diabetes (impaired fasting glucose of 100 to 125 mg/dL) or metabolic syndrome per American Heart Association/National Heart, Lung, and Blood Institute 2005 criteria. At baseline, patients had a mean BMI of 32 kg/m² and a mean age of 52.9 years; 53% were male.

Patients were randomized to a coach-led, small-group intervention; a self-directed DVD intervention; or usual care. For the intervention groups, a behavioral weight-loss curriculum was used in the three-month “intensive” phase, followed by a 12-month “maintenance” phase during which both groups received lifestyle change coaching and support via email and a website. Results were published online Dec. 10 by Archives of Internal Medicine.

The average change in BMI from baseline for the coach-led group was −2.2, compared to −0.9 in the usual care group (P<0.001) and −1.6 in the self-directed group (P<0.02 vs. usual care). Thirty-seven percent of patients in the coach-led group achieved the 7% weight-loss goal (P=0.003 vs. usual care) and 35.9% achieved it in the self-directed group (P=0.004 vs. usual care), compared to 14.4% in the usual care group. Improvements in waist circumference and fasting plasma glucose levels in both interventions also reached statistical significance compared with the usual group.

Study limitations include that participants were mainly of high socioeconomic status and from a single clinic, and the study didn't evaluate efficacy after 15 months or cost-effectiveness, they wrote. Women seemed to respond more favorably to the coach-led than the self-directed intervention, while men responded comparably to both, though these findings need to be confirmed, the authors noted. The two lifestyle interventions are “readily scalable and exportable” and “integrate standardized, DPP translational programs (delivered in groups or by DVD) with existing health [information technology],” for a primary care setting, the authors concluded.