CHICAGO – A proven weight-loss intervention can be delivered through primary care practices by telephone and improve weight loss in patients at risk for developing diabetes.
Moreover, group conference calls were even more effective than individual calls at keeping the weight off at 2 years, according to new results from the $3.2-million SHINE (Support, Health Information, Nutrition and Exercise) study.
"A telephone DPP [Diabetes Prevention Program] intervention is not only feasible, but effective," co-principal investigator Paula Trief, Ph.D., said at the annual scientific sessions of the American Diabetes Association.
The multicenter DPP research study demonstrated that a modest amount of weight loss through dietary changes and increased physical activity could sharply reduce the risk of developing diabetes, with several trials subsequently looking at how to deliver the DPP in the real world in a less costly but still effective manner. At the same time, the U.S. Preventive Services Task Force recommended that primary care providers offer, or refer patients to, weight loss interventions, in part because of their long-term relationship with patients.
The SHINE study put these two components together to determine whether primary care provider staff could be trained to deliver the DPP, and whether it could be adapted for telephone delivery to increase reach, explained Dr. Trief, professor of psychiatry and behavioral science, State University of New York (SUNY) Upstate Medical University in Syracuse.
Staff, mostly licensed practical nurses and dieticians, from five diverse primary care practices in upstate New York underwent 2 days of training, plus supervision to competence on individual goal setting, feedback, and problem solving for two DPP-based interventions.
A total of 257 patients with metabolic syndrome, but no diabetes, and a body mass index of at least 30 kg/m2 were randomly assigned to participate in the DPP lifestyle balance program as a group (n= 128) or individually (n= 129). Up to 8 patients were enrolled for each group conference call.
In year 1, an educator presented the 16-session DPP core curriculum during weekly phone calls for 5 weeks, then monthly thereafter. Coaches made monthly calls to improve adherence to the weight-loss strategies. In year 2, the educator made monthly calls and used topics from the after-core DPP curriculum, and the coach was available for up to 6 visits. Data are not yet available from year 3, the maintenance phase, in which quarterly contact was encouraged but not arranged by the investigators.
At baseline, the patients mean BMI was 39.3 kg/m2, mean weight 237 pounds (107.6 kg), mean waist circumference 46.6 inches (118.6 cm) and mean fasting glucose 99.6 mg/dL. Their average age was 51.7 years.
Their average fasting glucose was 99.6 mg/dL, blood pressure was 129 mm Hg/75.6 mm Hg, triglycerides were 145.7 mg/dL, high-density lipoprotein cholesterol was 42.4 mg/dL, and low-density lipoprotein cholesterol was 108.3 mg/dL.
At 1 year, patients in the solo and group intervention arms lost an average of 4.6 kg and 6.0 kg, respectively, according to data reported at last year’s AAD meeting by co-principal investigator Dr. Ruth Weinstock, MD, Ph.D., chief of endocrinology, diabetes and metabolism at SUNY and director of the Joslin Diabetes Center. Waist circumference was reduced by an average of -5.0 cm and -4.5 cm, respectively.
At 2 years, solo participants had improved weight loss, but also regained weight, while group participants had further weight loss, Dr. Trief said.
At 2 years, the average weight loss nearly tripled from 2.2 kg in the solo arm to 6.2 kg in the group intervention arm, while the average percent weight loss jumped from –1.8% to –5.6% in the group arm (both P = .01).
In all, 29% of the solo arm met their goal of losing at least 5% of their weight vs. 52.2% in the group arm (P = .01). Waist circumference reductions were statistically similar in the solo and group arms (–2.4 cm vs. –3.1 cm).
As for why the group intervention was more effective over time, Dr. Trief said it was conjecture but that: "It could be that these patients received better advice from their peers.
"When the educator was providing advice and direction, they were doing it based on a script, but the peers were offering all kinds of suggestions: ‘Oh, I tried this kind of food,’ ‘This is how I increased my activity.’ Again, it’s more real world," she said.
It also may be that patients are more likely to accept the advice of peers, may feel more accountable to peers trying to lose weight than to an educator or coach, may try to complete more topic sessions to "keep up" with their peers, and there’s the emotional support provided by the group, Dr. Trief observed.