Anzeige
Erschienen in:
21.01.2020 | Original Research
Effectiveness of Lifestyle Intervention for Type 2 Diabetes in Primary Care: the REAL HEALTH-Diabetes Randomized Clinical Trial
Erschienen in: Journal of General Internal Medicine | Ausgabe 9/2020
Einloggen, um Zugang zu erhaltenAbstract
Background
Intensive lifestyle interventions (LI) improve outcomes in obesity and type 2 diabetes but are not currently available in usual care.
Objective
To compare the effectiveness and costs of two group LI programs, in-person LI and telephone conference call (telephone LI), to medical nutrition therapy (MNT) on weight loss in primary care patients with type 2 diabetes.
Design
A randomized, assessor-blinded, practice-based clinical trial in three community health centers and one hospital-based practice affiliated with a single health system.
Participants
A total of 208 primary care patients with type 2 diabetes, HbA1c 6.5 to < 11.5, and BMI > 25 kg/m2 (> 23 kg/m2 in Asians).
Interventions
Dietitian-delivered in-person or telephone group LI programs with medication management or MNT referral.
Main Measures
Primary outcome: mean percent weight change. Secondary outcomes: 5% and 10% weight loss, change in HbA1c, and cost per kilogram lost.
Key Results
Participants’ mean age was 62 (SD 10) years, 45% were male, and 77% were White, with BMI 35 (SD 5) kg/m2 and HbA1c 7.7 (SD 1.2). Seventy were assigned to in-person LI, 72 to telephone LI, and 69 to MNT. The mean percent weight loss (95% CI) at 6 and 12 months was 5.6% (4.4–6.8%) and 4.6% (3.1–6.1%) for in-person LI, 4.6% (3.3–6.0%) and 4.8% (3.3–6.2%) for telephone LI, and 1.1% (0.2–2.0%) and 2.0% (0.9–3.0%) for MNT, with statistically significant differences between each LI arm and MNT (P < 0.001) but not between LI arms (P = 0.63). HbA1c improved in all participants. Compared with MNT, the incremental cost per kilogram lost was $789 for in-person LI and $1223 for telephone LI.
Conclusions
In-person LI or telephone group LI can achieve good weight loss outcomes in primary care type 2 diabetes patients at a reasonable cost.
Clinical Trial Registration
ClinicalTrials.gov Identifier: NCT02320253