Abstract
Aims: To evaluate metabolic and anthropometric changes achieved and maintained by diabetic patients (pts) in a structured weight loss (WL) program vs usual care in an endocrine clinic (UCG).Materials and Methods: This retrospective comparison study examined 38 diabetic pts with BMI >25 undergoing the active weight loss phase of WL determined by patient goal weight and then followed for 6 months in weight maintenance phase (WM). Multiple endpoints were assessed at baseline including BMI and hemoglobin A1c (A1c). Endpoints were reassessed at 6 months in WM. The usual care group (UCG) was obtained through chart review of 26 diabetic pts with BMI > 25 in an endocrine specialty clinic who completed an education program including lifestyle counseling by a certified diabetic educator. Data were analyzed using ANCOVA and protected LSD, adjusting for age, gender, and baseline weight.Results: Patients showed a change in BMI at 6 months of -6.8 ± 0 (bsl 44 ± 8.4) and -0.7 ± 1.1 (bsl 35 ± 6.2) for HMR® pts and UCG, respectively (p < 0.05). HMR® pts had 13.4% ± 3 % WL vs 7.9% ± 4% in UCG p = 0.34). 6 month A1c was similar in HMR pts (7.5% ± 2; bsl 8.3 ± 1.9) and UCG (7.5% ± 2.3; bsl 9.8 ± 1.8). HMR® pts had a reduction of total medication usage of 28%, with at least one medication discontinued in 80% of pts, while the UCG had only 23% of pts with discontinuation of at least one medication (p < 0.05). Conclusions: Compared to CDE-led diabetic education emphasizing lifestyle change, pts in an intensive WL program utilizing weekly coaching, meal replacements, and exercise, had a significant decrease in BMI and achieved a similar A1c with reduction in medication requirements.
Highlights
A recent assessment of the 2005 U.S National Ambulatory Medical Care Survey (NAMCS) indicated that a significant proportion of U.S ambulatory patients with Type 2 diabetes mellitus present with obesity and greater clinical acuity than patients with diabetes alone[1]
The usual care group consisted of diabetic patients treated for weight loss as part of their routine care at the Endocrine Specialty Clinic, University of Kentucky, who received lifestyle education in a AADE certified education program led by a certified diabetes educator (CDE)
Analysis of insulin use demonstrated a decrease in Health Management Resources (HMR) patients of 32.88 ± 12.63 units per day and an increase of 18.88 ± 9.16 units per day in the control group from baseline to 6 month follow up(p < 0.05) (Figure 5)
Summary
A recent assessment of the 2005 U.S National Ambulatory Medical Care Survey (NAMCS) indicated that a significant proportion of U.S ambulatory patients with Type 2 diabetes mellitus present with obesity and greater clinical acuity than patients with diabetes alone[1] This rising prevalence of obesity in diabetic patients has significantly contributed to the complexity of medical management due to the subsequent comorbidities, and most healthcare providers struggle with this aspect of care in their diabetic patients. The ADA guidelines suggest that non-surgical approaches to weight loss including a variety of differently composed macronutrient diets which promote energy-restricted eating patterns, combined with physical activity and behavior modification, may be effective in achieving clinically significant weight loss. They further promote that intensive lifestyle programs with frequent follow up are often required to achieve significant reductions excess weight[4]
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