Structured weight management programs work in the real world
medwireNews: Real-life data show that a structured weight management program can lead to sustained weight loss, improved glycemic control, and a reduced need for medication in patients with type 2 diabetes.
However, getting a higher proportion of patients referred to and engaged with interventions remains a challenge, Jennifer Logue (University of Glasgow, UK) and co-investigators report in Diabetes, Obesity and Metabolism.
The researchers reviewed the electronic health records of 23,208 patients with type 2 diabetes and obesity in Glasgow, Scotland, between 2005 and 2014.
During this time, 3471 (15.0%) were referred to a time-limited educational lifestyle program that included cognitive behavioral therapy, a 600 kcal deficit diet, and physical activity advice.
Referred patients tended to be younger, with a higher BMI, and worse glycemic control, and were more likely to be White, female, and less socioeconomically deprived than those who were not referred.
Of the patients referred, 1537 (44.3%) attended at least one session, with 808 (23.3%) completing the intervention by attending seven to nine sessions and 334 (9.7%) successfully losing at least 5 kg during the first 16 weeks.
The researchers found that the successful completers maintained significantly greater average weight loss at 3 years (–8.03 kg) than unsuccessful completers (i.e., those that lost <5 kg; –4.26 kg), non-completers (–3.26 kg), and those not referred to the service (–1.00 kg).
Successful completers were also the only patient group not to significantly increase their use of diabetes medication or insulin over 3 years. By contrast, the number of unique diabetes medications increased by 0.30–0.39 in the comparator groups, while insulin use increased by 2.7–7.0%.
Furthermore, after adjustment for potential confounders such as age, sex, BMI, time since diagnosis, baseline glycated hemoglobin (HbA1c), and medication use, successful completers had a clinically and statistically significant reduction in HbA1c of 3.7 mmol/mol at 3 years compared with non-completers and unsuccessful completers.
Weight and the number of unique diabetes medications used were also significantly lower among the successful completers in the adjusted analyses, whereas insulin use was not.
Logue et al say they “feel strongly that the fact that those who did lose weight maintained that weight loss and had clinically meaningful improvements in glycaemic control, shows the potential of weight management interventions in type 2 diabetes to improve clinical outcomes.”
They conclude: “Given this clinical potential, there is an urgent need for more research in this area to develop and deliver interventions that are accessible for all our patients,”
By Laura Cowen
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