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J Gen Intern Med. 2020 Jan 21. doi: 10.1007/s11606-019-05629-9. [Epub ahead of print]

Effectiveness of Lifestyle Intervention for Type 2 Diabetes in Primary Care: the REAL HEALTH-Diabetes Randomized Clinical Trial.

Author information

1
Diabetes Unit, Department of Medicine, Massachusetts General Hospital (MGH) Diabetes Research Center, Boston, MA, USA. delahanty.linda@mgh.harvard.edu.
2
Harvard Medical School, Boston, MA, USA. delahanty.linda@mgh.harvard.edu.
3
Harvard Medical School, Boston, MA, USA.
4
Mongan Institute Health Policy Research Center, MGH, Boston, MA, USA.
5
Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA.
6
Diabetes Unit, Department of Medicine, Massachusetts General Hospital (MGH) Diabetes Research Center, Boston, MA, USA.
7
MGH Chelsea Health Center, Boston, MA, USA.
8
MGH Charlestown Health Center, Boston, MA, USA.
9
MGH Revere Health Center, Boston, MA, USA.

Abstract

BACKGROUND:

Intensive lifestyle interventions (LI) improve outcomes in obesity and type 2 diabetes but are not currently available in usual care.

OBJECTIVE:

To compare the effectiveness and costs of two group LI programs, in-person LI and telephone conference call (telephone LI), to medical nutrition therapy (MNT) on weight loss in primary care patients with type 2 diabetes.

DESIGN:

A randomized, assessor-blinded, practice-based clinical trial in three community health centers and one hospital-based practice affiliated with a single health system.

PARTICIPANTS:

A total of 208 primary care patients with type 2 diabetes, HbA1c 6.5 to < 11.5, and BMI > 25 kg/m2 (> 23 kg/m2 in Asians).

INTERVENTIONS:

Dietitian-delivered in-person or telephone group LI programs with medication management or MNT referral.

MAIN MEASURES:

Primary outcome: mean percent weight change.

SECONDARY OUTCOMES:

5% and 10% weight loss, change in HbA1c, and cost per kilogram lost.

KEY RESULTS:

Participants' mean age was 62 (SD 10) years, 45% were male, and 77% were White, with BMI 35 (SD 5) kg/m2 and HbA1c 7.7 (SD 1.2). Seventy were assigned to in-person LI, 72 to telephone LI, and 69 to MNT. The mean percent weight loss (95% CI) at 6 and 12 months was 5.6% (4.4-6.8%) and 4.6% (3.1-6.1%) for in-person LI, 4.6% (3.3-6.0%) and 4.8% (3.3-6.2%) for telephone LI, and 1.1% (0.2-2.0%) and 2.0% (0.9-3.0%) for MNT, with statistically significant differences between each LI arm and MNT (P < 0.001) but not between LI arms (P = 0.63). HbA1c improved in all participants. Compared with MNT, the incremental cost per kilogram lost was $789 for in-person LI and $1223 for telephone LI.

CONCLUSIONS:

In-person LI or telephone group LI can achieve good weight loss outcomes in primary care type 2 diabetes patients at a reasonable cost.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov Identifier: NCT02320253.

KEYWORDS:

cost-effectiveness; lifestyle intervention; primary care; type 2 diabetes; weight loss interventions

PMID:
31965526
DOI:
10.1007/s11606-019-05629-9

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