Brief report
Sustained weight loss one year after group telephone intervention: 3-Year results from the SHINE study

https://doi.org/10.1016/j.diabres.2014.09.032Get rights and content

Highlights

  • We compared group to individual telephonic translation of the DPP intervention.

  • At 3 years both interventions led to significant weight loss compared to baseline.

  • At 3 years, group participants maintained weight loss, individual participants regained.

  • Group intervention was more effective than individual for maintaining weight loss.

Abstract

A telephone delivered translation of the DPP weight loss program, delivered by trained primary care staff over 2 years, resulted in significant weight loss for patients with metabolic syndrome. Participants in groups (conference calls) continued to lose weight a full year after the program ended, while those called individually regained.

Introduction

Thirty-four per cent of adults in the U.S. are diagnosed with metabolic syndrome [IDF criteria [1] and BMI ≥30 kg/m2]. In the Diabetes Prevention Program (DPP) patients at risk for diabetes who lost weight, including those with metabolic syndrome, reduced their risk of developing diabetes [2], [3], [4], [5]. Many have tested DPP translations that have greater reach and lesser cost, and overall, these translations do achieve weight loss [6]. However, few report on the maintenance of weight loss.

We have previously reported results of the SHINE (Support, Health Information, Nutrition and Exercise) study. Primary care (PCP) staff delivered the DPP intervention on the telephone, in groups (CC: conference calls) or individually (IC: individual calls) [7]. The phone can increase access for those with disabilities, transportation or time barriers. After the two year intervention ended, we followed participants for one year. Here we report the 3 year results. Primary outcomes were change in weight/BMI/waist circumference at end of year-3.

Section snippets

Participants and methods

A detailed description of SHINE has been published [7]. Inclusion criteria: >18 years, with metabolic syndrome [IDF criteria [8], and BMI ≥30 kg/m2], recruited 6/09–11/10, provided informed consent. Exclusion criteria: diagnosed diabetes, presence of severe medical problems that could affect participation. Five diverse (rural, small city, medium-sized city/poor, medium-sized city/moderate income) upstate NY PCP sites participated. SHINE was approved by the Institutional Review Board at SUNY

Results

See Table 1 for demographic and baseline measures. See Table 2 and Fig. 1 for outcome data for both arms at each assessment point. Absolute weight loss, change in BMI and waist circumference was comparable for CC and IC groups at year-1. At year-2 and year-3 (one year after completion of all intervention contact) IC participants regressed somewhat, while CC participants continued to improve or maintained. At year-3, CC adjusted mean weight decreased 6.44 kg (±15.61, p < .001), whereas IC decreased

Discussion

In SHINE, a real-world, DPP telephone adaptation intervention delivered by PCP staff to patients with metabolic syndrome, group participants were more likely than individual participants to maintain weight loss after a full year with no intervention. Studies show that weight loss maintenance is challenging, the majority regain [9], [10]. However, comparisons are difficult since most do not report long-term data after program completion [6]. The DPP group assessed weight at >3 years, but the

Conflict of interest disclosures

None.

Acknowledgments

Contributors: We thank our participants, their primary care providers, the health care professionals who served as educators, and our dietician coaches. We also thank Philip Morin, MS for project management, Julie J. Stone, RN for performing the participant assessments, and Jane D. Bulger, MS, CCRC and Michael J. Wade, MS for facilitating data collection and entry. Funders: This study was supported by grant R18-DK078553 from the National Institutes of Health (NIDDK; Trief and Weinstock PIs).

References (16)

  • K.G. Alberti et al.

    The metabolic syndrome – a new worldwide definition

    Lancet

    (2005)
  • J.M. Boltri et al.

    Translation of the National Institutes of Health Diabetes Prevention Program in African American churches

    J Natl Med Assoc

    (2011)
  • A. Mozumdar et al.

    Persistent increase of prevalence of metabolic syndrome among U.S. adults: NHANES III to NHANES 1999–2006

    Diabetes Care

    (2011)
  • W.C. Knowler et al.

    Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin

    N Engl J Med

    (2002)
  • W.C. Knowler et al.

    10-Year follow-up of diabetes incidence and weight loss

    Lancet

    (2009)
  • W.H. Hernan et al.

    Costs associated with the primary prevention of type 2 diabetes mellitus in the diabetes prevention program

    Diabetes Care

    (2003)
  • T.J. Orchard et al.

    The effect of metformin and intensive lifestyle intervention on the metabolic syndrome: the Diabetes Prevention Program randomized trial

    Ann Intern Med

    (2005)
  • M.K. Ali et al.

    How effective were lifestyle interventions in real-world settings that were modeled on the Diabetes Prevention Program?

    Health Aff. (Millwood)

    (2012)
There are more references available in the full text version of this article.

Cited by (0)

Trial registration: clinicaltrials.gov identifier: NCT00749606.

View full text