Randomized trial of community-based intensive lifestyle intervention for adults with type 2 diabetes: Translating research into practice to impact population health
Methods: The trial enrolled 331 adults with BMI ≥24 kg/m2and prior diagnosis of type 2 diabetes. Participants were randomized to either: (1) control - brief lifestyle counseling with nearby community resource information; or (2) intervention - encouragement to participate in a group-based adaptation of the LookAHEAD program offered free-of-charge by the YMCA. The primary outcome was mean difference in body weight at 6 months. Secondary outcomes included changes in HbA1c, cholesterol, and blood pressures. Intent-to-treat analyses used mixed-effects regression models (maximum likelihood estimation) that adjusted for weight at baseline.
Results: Participants had a mean (SD) age of 57.4 ± 11.4 years, BMI 35.6± 7.6 kg/m2, HbA1c 7.22 ± 1.25%. Approximately half (50.2%) were women, 30.5% were African American, 34.4% were non-Hispanic White, and 27.5% were Hispanic. Approximately one third (35.3%) reported annual household income of <$25,000. Compared to controls, participants randomized to the group lifestyle intervention lost an additional 1.29 kg (95% CI 0.47 – 2.14 kg) at 6 months, regardless of intervention attendance. Differences in mean weight loss were not statistically significant across race/ethnicity. Future analyses will include comparisons at 12 months and 24 months.
Conclusions: Delivery of a group adaptation of the LookAHEAD program by YMCAs results in a scalable lower cost mechanism to help patients with type 2 diabetes lose weight. Health care reform models and reimbursement policies should include access to community-based intensive healthy lifestyle interventions to translate interventions into practice.
Learning Areas:Administer health education strategies, interventions and programs
Chronic disease management and prevention
Conduct evaluation related to programs, research, and other areas of practice
Public health or related organizational policy, standards, or other guidelines
Public health or related research
Analyze the association between participation in a community-based lifestyle program and weight loss for patients with type 2 diabetes. List the barriers for adults with diabetes to engage in healthy eating and exercise behaviors. Describe the potential impact of community-based intensive healthy lifestyle interventions on health care reform models and reimbursement policies.
Keyword(s): Diabetes, Health Care Costs
Qualified on the content I am responsible for because: I have been a co-investigator of multiple federally funded grants focusing on training CHWs to deliver lifestyle behavior change interventions to patients with diabetes and prediabetes. My research focuses on the development of strategies for coordination of health promotion and disease prevention across healthcare and community settings in hopes that health care costs can be lowered.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.