Main Category: Diabetes
Also Included In: Obesity / Weight Loss / Fitness
Article Date: 30 Jun 2010 – 11:00 PDT

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A community-based lifestyle intervention program, modeled after one used in a landmark government funded diabetes-prevention study, can help participants in a group setting achieve weight loss and blood glucose reductions comparable to those achieved with individual counseling from health professionals, according to data presented by researchers at the American Diabetes Association’s 70th Scientific Sessions®.

In the Healthy Living Partnerships to Prevent Diabetes (HELP PD) study, participants were divided into two groups: a lifestyle weight loss group, which received six months of weekly behavioral weight loss sessions in a group setting, followed by monthly follow-up meetings, at which they were encouraged to change eating behaviors and exercise up to 180 minutes per week; and a usual care group, which received two visits with a dietitian and a quarterly newsletter with tips for lifestyle changes. The group weight loss sessions were delivered by lay community health workers trained and supervised by dietitians at the Wake Forest Diabetes Care Center in Winston-Salem, North Carolina.

The study found that those in the lifestyle intervention group achieved and maintained significantly greater weight loss (an average of 7.3 percent of body weight) than those in the regular care group (who achieved an average loss of just 1.3 percent of body weight) after 12 months. The lifestyle intervention group also reduced blood glucose levels by an average of over 4 mg/dl, from 105.8 mg/dl to 101.2 mg/dl, after 12 months, compared to an average drop of less than 2 mg/dl (to 104 mg/dl) for the regular care group. The results for the lifestyle group mirrored those achieved over three years by participants in the landmark National Institutes of Health-sponsored Diabetes Prevention Program, in which individuals with glucose levels in the pre-diabetic range were able to reverse the course of their disease by losing 5-7 percent of body weight and exercising 150 minutes per week, in addition to receiving individual counseling sessions with trained behavioralists. In the Diabetes Prevention Program, the weight loss program led to a 58 percent reduction in the development of diabetes, from about 11 percent a year to about 5 percent a year.

“In the Diabetes Prevention Program, professional behavioral specialists worked with participants with pre-diabetes in one-on-one sessions. We trained some of our patients with diabetes to work as lay community health workers with groups of participants with pre-diabetes, so we really didn’t expect to see quite as good a weight loss result as we did, but we were very pleased to see it,” said David Goff, MD, Chair of the Department of Epidemiology and Prevention at Wake Forest University School of Medicine, and lead researcher on the study. “Given that our weight loss results look as good as the DPP, this approach shows great promise for preventing diabetes. It’s a very translatable intervention to deliver in public health settings. We think this approach could be replicated at Diabetes Care Centers across the country.”

There are more than 3,000 such centers in the United States, with on-site physicians, diabetes educators and facilities that can be used for delivering the type of group intervention employed in this study. However, the intervention can be delivered in any setting where community health workers have access to a room large enough for about a dozen people to meet, a television, a DVD player, and a scale, Dr. Goff said.

The HELP PD model relies upon DVDs developed by the research team that give participants information about healthy eating, proper stretching and exercise tips, how to eat “mindfully” (i.e. not out of boredom or habitually in front of the television) and other lifestyle-related topics. Dr. Goff said that training community health workers to coach participants on how to set goals, solve problems and use the information in the DVDs could be accomplished by others interested in starting such a program in their own community. Reimbursement for these programs is a barrier.

Study participants will be followed for an additional five years to see whether individuals can maintain weight loss and blood glucose reductions independently, or if they need continued group counseling to do so. The study is being funded by the National Institute of Diabetes and Digestive and Kidney Diseases, part of the National Institutes of Health.

HELP PD is one of numerous community-centered intervention models being developed based upon a program used during the DPP. Several different programs, tested in a variety of community settings, will be discussed and presented during the Association’s 70th Scientific Sessions, including the Group Lifestyle Balance Program, which helped significantly reduce diabetes risk factors through group settings at a primary care practice in California and also through DVDs that could be viewed at home (105-OR). This program was also successful when delivered by diabetes educators (417-PP). Another focused on Arab Americans in the Detroit, Michigan area, who successfully reached weight loss and physical activity goals through a program culturally modified to suit Middle Eastern diet and values (110-OR). And African Americans recruited during Sunday services at 42 churches in Georgia and Connecticut showed promising initial weight loss and a high willingness to participate in a church-based, culturally adapted lifestyle change program, according to preliminary data (109-OR).

Source:
American Diabetes Association

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