Clinic Based, Patient Choice Driven Lifestyle Intervention Lowers HbA1c In Type 2 Diabetes

Abstract

The hyperglycemia associated with type 2 diabetes (T2D) results in substantially increased morbidity and mortality risk. Though efficacious pharmacotherapies exist, glycemic control remains poor with 33-49% of patients not meeting targets for glycemic control as quantified by HbA1c. While traditional lifestyle interventions have been shown to improve health outcomes, adherence is low. PURPOSE: This study sought to determine the efficacy of a clinic-based, menu-driven intervention on measures of glycemia and cardiovascular health. METHODS: Patients with T2D (n = 20; 56.7 ± 12y; 33.7 ± 7.2 BMI) with an HbA1c of 7.5-10% not requiring injectable insulin were recruited from an outpatient, family medicine clinic in Phoenix, AZ and underwent a quasi-experimental 3-month lifestyle intervention. In addition to behavioral counseling, subjects were given a daily menu of exercise and nutritional options and had to choose one option from each category. Exercise options: Moderate intensity (MOD) 3 x 10-minute bouts, MOD 1 x 30-minute bout, 2 minutes every hour at a high or MOD, and 10 x 1-minute bouts of high intensity (RPE 17-19). The dietary choices included: apple cider vinegar, psyllium husk powder, unsalted tree nuts, avocados, or extra virgin olive oil. Behavioral health counseling utilized motivational interviewing, acceptance and commitment therapy, and problem-solving therapy to promote behavior change. The intervention was administered to patients by medical assistants in a family medicine clinic and overseen by exercise physiologists and physicians. Wilcoxon Signed Rank tests were used to analyze pre- and post-intervention differences. RESULTS: A reduction in HbA1c of 0.5% was observed after the intervention (8.6 ± 0.9 vs. 8.1 ± 1.2% respectively; p = 0.05). Additionally, there was a reduction in waist circumference (115.5 ± 12.6 vs. 112.5 ± 15.2 cm; p = 0.014), body weight (97.7 ± 21.9 vs. 95.6 ± 23.9 kg; p = 0.016), and BMI (33.7 ± 7.2 vs 32.8 ± 7.5 kg/m2; p = 0.028). CONCLUSIONS: Our pilot data suggest that a lifestyle intervention administered by medical assistants in a family medicine clinic demonstrates improvements in glycemic control, waist circumference, and BMI in T2D. These results remain to be verified in a randomized controlled trial setting. Funding: Dignity Health/ASU Strategic Initiatives Program