Abstract
Objective:To investigate whether the effects on weight loss and cardiometabolic risk factor reduction of two technology-mediated lifestyle interventions for 15 months in a primary care-based translation trial sustained at 24 months (that is, 9 months after the end of intervention).Design:This study analyzed data from an extended follow-up of participants in the original ‘E-LITE' (Evaluation of Lifestyle Interventions to Treat Elevated Cardiometabolic Risk in Primary Care)-randomized controlled trial, which demonstrated the effectiveness of two adapted Diabetes Prevention Program (DPP) lifestyle interventions compared with usual primary care.Subjects:E-LITE randomized 241 overweight or obese participants with pre-diabetes and/or metabolic syndrome to receive usual care alone (n=81) or usual care plus a coach-led (n=79) or self-directed intervention (n=81). The interventions provided coach-led group behavioral weight-loss treatment or a take-home, self-directed DVD using the same 12-week curriculum, followed by 12 additional months of technology-mediated coach contact and self-monitoring support. Participants received no further intervention after month 15. A blinded assessor conducted 24-month visits by following the measurement protocols of the original trial. Measurements include weight and cardiometabolic risk factors (waist circumference, fasting plasma glucose, resting blood pressure, triglycerides, high- and low-density lipoprotein cholesterol, total cholesterol and triglyceride to high-density lipoprotein cholesterol ratio).Results:At month 24, mean±s.e. changes in body mass index (trial primary outcome) and weight (kg) from baseline were –1.9±0.3 (P=0.001) and –5.4±0.9 (P<0.001) in the coach-led intervention, and –1.6±0.3 (P=0.03) and –4.5±0.9 (P=0.001) in the self-directed intervention, compared with –0.9±0.3 and 2.4±0.9 in the usual care group. In addition, both interventions led to a greater percentage of participants maintaining ⩾7% weight loss and sustained improvements in waist circumference and fasting plasma glucose levels than usual care.Conclusion:This study shows sustained benefits of the two primary care-based, technology-mediated DPP lifestyle interventions. The findings warrant replication in long-term studies involving diverse populations.
Highlights
We previously published findings from E-LITE (Evaluation of Lifestyle Interventions to Treat Elevated Cardiometabolic Risk in Primary Care), a three-arm randomized trial, demonstrating the effectiveness of two adapted Diabetes Prevention Program (DPP) lifestyle interventions for weight loss and cardiometabolic risk factor reduction among overweight or obese participants with pre-diabetes and/or metabolic syndrome over 15 months of follow-up compared with usual care.[1]
Significant improvements were maintained at 24 months for waist circumference and fasting plasma glucose level in the coach-led (Po0.001 for both) and selfdirected interventions (Po0.001 and P 1⁄4 0.04, respectively), triglyceride to high-density lipoprotein ratio in the coach-led intervention (P 1⁄4 0.03) and total cholesterol level in the self-directed intervention (P 1⁄4 0.04)
No sponsor or funding source had a role in the design or conduct of the study; collection, management, analysis or interpretation of the data; or preparation, review or approval of the manuscript. This extended study shows that the previously demonstrated effects of the two primary care-based, technology-enhanced DPP lifestyle interventions on weight loss and cardiometabolic risk factors persisted through 24 months after treatment initiation (21 months after completion of the intensive treatment phase and 9 months after completion of the maintenance phase)
Summary
We previously published findings from E-LITE (Evaluation of Lifestyle Interventions to Treat Elevated Cardiometabolic Risk in Primary Care), a three-arm randomized trial, demonstrating the effectiveness of two adapted Diabetes Prevention Program (DPP) lifestyle interventions for weight loss and cardiometabolic risk factor reduction among overweight or obese participants with pre-diabetes and/or metabolic syndrome over 15 months of follow-up compared with usual care.[1]. We hypothesized that participants of both E-LITE interventions would sustain greater weight loss and improvements in cardiometabolic risk factors (for example, waist circumference and fasting plasma glucose levels) at 24 months than controls
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