Diabetic Instructors Help Neighbors Lose Weight, Improve Glucose Profiles

Neil Osterweil

July 02, 2010

July 2, 2010 (Orlando, Florida) — A community-based health intervention styled after the Diabetes Prevention Program (DPP) helped adults at risk for diabetes lose significant amounts of weight and pull their belts in by a notch or 2, reported investigators here at the American Diabetes Association 70th Scientific Sessions.

Dr. David Goff

The Healthy Living Partnership to Prevent Diabetes (HELP-PD) helped 301 overweight or obese adults with prediabetes reduce their body weight by more than 7% on average, and reduce waist circumference by about 5 cm in 1 year, said David C. Goff, Jr., MD, chair of the Department of Epidemiology and Prevention at Wake Forest University School of Medicine in Winston-Salem, North Carolina.

"Our reduction in glucose of 4 mg/dL is comparable to the DPP and to the Finnish Diabetes Prevention Study. Those differences were associated with about a 50% reduction in the incidence of diabetes, so we believe this is a clinically meaningful reduction in glucose. We also had substantial reductions in insulin and in the homeostasis model assessment for insulin resistance [HOMA-IR]," reported Dr. Goff.

Dr. Robert Ratner

The study results are encouraging, and can be replicated in the more the 3000 diabetes care programs around the United States, said Robert Ratner, MD, senior scientist at the MedStar Health Research Institute and professor of medicine at Georgetown University School of Medicine in Washington, DC. Dr. Ratner was not involved in the study, but commented on it for Medscape Medical News.

"I think we need as many outlets for diabetes education and diabetes prevention as we can find," he said. "What we can do is provide a whole variety of outlets to meet the needs of communities. They need to be data driven; they need to show that they can actually accomplish the intended goal in order to justify the expenditure."

HELP-PD is a randomized trial based in Forsyth County, North Carolina. It tests a group-based rather than individual-oriented behavioral lifestyle-change strategy with the goal of weight loss and diabetes prevention. Control subjects receive usual care.

The program is delivered through local diabetes care centers by registered dietitians and community health workers, who are diabetes patients identified as good candidates for training and group leadership. Initial participation in the study was planned for 2 years, and the investigators have recently received funding from the National Institute of Diabetes and Digestive and Kidney Diseases for extended follow-up.

Participants are 21 years or older with a body mass index (BMI) from 25 to 40 kg/m2, 2 fasting glucose readings from 95 to 125 mg/dL, and no previous diagnosis of diabetes or cardiovascular disease. The investigators did not use the oral glucose tolerance test because it is not commonly used in the community, Dr. Goff said.

The participants were randomized to the support group or usual care. The support group had 3 sessions with a registered dietitian during the first 6 months, and attended group meetings led by lay community health workers focused on weight loss, physical activity, and nutrition. The meetings were held weekly for the first 6 months, then monthly for the 18-month maintenance phase. The usual-care group had 2 sessions with a registered dietitian during the first 3 months, and received monthly newsletters about community resources for weight loss.

The primary end point is fasting glucose. Other end points are change in weight, percentage of body weight, BMI, waist circumference, fasting glucose, insulin, and HOMA-IR over the first year based on measures at 6 and 12 months.

At 12-month follow-up, mean fasting glucose had declined to a significantly greater degree in the support group than in the usual-care group (–4.2 mg/dL vs +0.3 mg/dL; < .001).

At the same time, the support group had lost a mean of 7.1 kg, compared with 1.5 kg for the usual-care group (< .001). The mean weight loss was 7.3% for the support group and 1.3% for the usual-care group (< .001).

There were also significant differences in BMI changes (–2.2 kg/m2 vs +0.3 kg/m2; P < .001), waist circumference (–5.9 cm vs –0.8 cm), fasting insulin (–6.6 µU/mL vs –2.7 µU/ml; < .001), and fasting HOMA-IR (< .001).

There were no significant differences in serious adverse events or incident diabetes, defined as a fasting glucose level above 126 mg/dL or use of diabetes medications at clinic visit.

Dr. Ratner said programs such as HELP-PD can help primary care practitioners provide needed lifestyle interventions for their patients at risk for diabetes.

"Clinicians are overwhelmed by patients with obesity complications, especially diabetes. They're looking for a way to solve the problem, and they don't personally have time — and frankly many don't have the expertise — to really provide that type of lifestyle instruction. There are 26 million people with diabetes in this country, and if every one of them became a lay instructor, we could cover everybody," Dr. Ratner said.

Dr. Ratner and Dr. Goff have disclosed no relevant financial relationships.

American Diabetes Association (ADA) 70th Scientific Sessions. Presented June 29, 2010.

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