medwireNews: Adding intensive weight management to group medical visits (GMVs) for type 2 diabetes leads to greater weight loss, reduced medication use, and fewer hypoglycemic events, with a similar improvement in glycemic control, research shows.
William Yancy Jr (Duke Diet and Fitness Center, Durham, North Carolina, USA) and colleagues explain that GMVs for people with diabetes have traditionally improved glycemic control “by intensifying medications, which infrequently led to weight loss.”
“Incorporating GMVs with intensive dietary change could enable weight loss and improve glycemia while decreasing medication intensity,” they remark.
To test this hypothesis, the researchers randomly assigned 263 outpatients with type 2 diabetes, uncontrolled glycated hemoglobin (HbA1c; mean 9.1%), and a BMI of at least 27 kg/m2 (mean 35.3 kg/m2) to attend a program of evidence-based GMVs with or without an evidence-based weight management program.
Individuals randomly assigned to the GMV program alone (n=136) received counseling about diabetes-related topics with medication optimization every 4 weeks for 16 weeks, and every 8 weeks thereafter for a total of nine visits. After 48 weeks, mean HbA1c had fallen to 8.3% in this group.
A similar fall, to 8.2%, was observed among the 127 people assigned to the GMV plus weight management group. This group received advice on low-carbohydrate nutrition, physical activity, and weight management, along with baseline medication reduction and subsequent medication optimization every 2 weeks for 16 weeks followed by a condensed GMV program every 8 weeks for a total of 13 visits.
The researchers also found that, at 48 weeks, people who received weight management advice in addition to the GMV program had significantly lower diabetes medication use (mean medication effect score 2.2 vs 2.7 points, from a baseline of 2.3), significantly greater weight loss (mean 4.1 vs 0.4 kg), and a significant 51% fewer hypoglycemic events (mean 3.2 vs 6.6 events), than those who attended the GMV program alone.
In addition, diabetes distress, measured using the Problem Areas in Diabetes score was significantly lower in the in the GMV plus weight management group than in the GMV only group at weeks 16 and 32, but was no longer different between the two groups by week 48.
The team also notes that at week 16, after the intensive initial phase of the weight management/GMV program, HbA1c was 0.7% lower than in the GMV arm.
Yancy Jr et al therefore question “whether these differences may have been more durable had the intervention persisted at a higher frequency (than every 2 months).”
Writing in JAMA Internal Medicine, the authors conclude: “When GMVs are used for diabetes, [weight management]/GMV should be considered as an alternative, noninferior approach for glycemic management that has additional clinical advantages.”
By Laura Cowen
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JAMA Intern Med 2019; doi:10.1001/jamainternmed.2019.4802