Lifestyle Intervention For Adults Research Articles

Barriers and Enablers to Maintaining Behaviour Changes Following a Lifestyle Intervention for Adults With Type 2 Diabetes

Aim To explore short-term barriers and enablers to maintaining behaviour changes in adults with type 2 diabetes who had completed a lifestyle behaviour change program. Methods Focus groups with 44 participants identified barriers and enablers at the end-of-program (n = 8 groups: anticipated); and, 1-month post-program (n = 6 groups: experienced). Thematic inductive analysis was undertaken independently by two authors, discussed, then deductively grouped according to the Capability (physical, psychological), Opportunity (physical, social), Motivation (automatic, reflective) – Behaviour (COM-B) model. Results Nine barriers were identified: two anticipated, one experienced, and six common to both timepoints. Key barriers related to physical capability (health ability), physical opportunity (difficulty accessing and using resources), social opportunity (unwillingness to invest in social networks), and reflective motivation (lack of internal drive). Eleven enablers were identified: all across both timepoints. Key enablers related to psychological capability (knowledge), physical opportunity (access and use of program resources), social opportunity (sense of belonging and safety within the program), automatic motivation (beliefs and awareness around perceived risk; monitoring of progress), and reflective motivation (committed to change). Discussion Findings suggest diabetes management programs should enable ongoing access to their resources. Investing in mechanisms to scaffold program graduates into suitable community-based activities may also be beneficial.

Combining diaries and accelerometers to explain change in physical activity during a lifestyle intervention for adults with pre-diabetes: A PREVIEW sub-study.

Self-report and device-based measures of physical activity (PA) both have unique strengths and limitations; combining these measures should provide complementary and comprehensive insights to PA behaviours. Therefore, we aim to 1) identify PA clusters and clusters of change in PA based on self-reported daily activities and 2) assess differences in device-based PA between clusters in a lifestyle intervention, the PREVIEW diabetes prevention study. In total, 232 participants with overweight and prediabetes (147 women; 55.9 ± 9.5yrs; BMI ≥25 kg·m-2; impaired fasting glucose and/or impaired glucose tolerance) were clustered using a partitioning around medoids algorithm based on self-reported daily activities before a lifestyle intervention and their changes after 6 and 12 months. Device-assessed PA levels (PAL), sedentary time (SED), light PA (LPA), and moderate-to-vigorous PA (MVPA) were assessed using ActiSleep+ accelerometers and compared between clusters using (multivariate) analyses of covariance. At baseline, the self-reported "walking and housework" cluster had significantly higher PAL, MVPA and LPA, and less SED than the "inactive" cluster. LPA was higher only among the "cycling" cluster. There was no difference in the device-based measures between the "social-sports" and "inactive" clusters. Looking at the changes after 6 months, the "increased walking" cluster showed the greatest increase in PAL while the "increased cycling" cluster accumulated the highest amount of LPA. The "increased housework" and "increased supervised sports" reported least favourable changes in device-based PA. After 12 months, there was only minor change in activities between the "increased walking and cycling", "no change" and "increased supervised sports" clusters, with no significant differences in device-based measures. Combining self-report and device-based measures provides better insights into the behaviours that change during an intervention. Walking and cycling may be suitable activities to increase PA in adults with prediabetes.

Tirzepatide after intensive lifestyle intervention in adults with overweight or obesity: the SURMOUNT-3 phase 3 trial

The effects of tirzepatide, a glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonist, on weight reduction after successful intensive lifestyle intervention are unknown. This double-blind, placebo-controlled trial randomized (1:1) adults with body mass index ≥30 or ≥27 kg/m2 and at least one obesity-related complication (excluding diabetes), who achieved ≥5.0% weight reduction after a 12-week intensive lifestyle intervention, to tirzepatide maximum tolerated dose (10 or 15 mg) or placebo once weekly for 72 weeks (n = 579). The treatment regimen estimand assessed effects regardless of treatment adherence in the intention-to-treat population. The coprimary endpoint of additional mean per cent weight change from randomization to week 72 was met with changes of −18.4% (standard error (s.e.) 0.7) with tirzepatide and 2.5% (s.e. 1.0) with placebo (estimated treatment difference −20.8 percentage points (95% confidence interval (CI) −23.2%, −18.5%; P < 0.001). The coprimary endpoint of the percentage of participants achieving additional weight reduction ≥5% was met with 87.5% (s.e. 2.2) with tirzepatide and 16.5% (s.e. 3.0) with placebo achieving this threshold (odds ratio 34.6%; 95% CI 19.2%, 62.6%; P < 0.001). The most common adverse events with tirzepatide were gastrointestinal, with most being mild to moderate in severity. Tirzepatide provided substantial additional reduction in body weight in participants who had achieved ≥5.0% weight reduction with intensive lifestyle intervention. ClinicalTrials.gov registration: NCT04657016.

Modern approaches to the management of patients with obesity (according to the materials of the Consensus of the American Gastroenterological Association in 2022)

Over the past few decades, the prevalence of obesity has increased dramatically worldwide. Obesity‑related complications such as cardiovascular disease, stroke, type 2 diabetes mellitus, nonalcoholic steatohepatitis, obstructive sleep apnea, osteoarthritis, and certain cancers (eg, colorectal cancer) have also increased, contributing to the high incidence and mortality. Lifestyle modification is the mainstay of long‑term treatment for obesity, but it has limited effectiveness and durability for most people. Pharmacotherapies developed and approved for the long‑term management of obesity are more effective in achieving weight loss, although the daily use of anti‑obesity medications is limited for many reasons. Prioritizing the development of clinical guidelines to inform the use of pharmacologic therapy for the long‑term treatment of obesity in adults, the American Gastroenterological Association published its consensus in 2022 that addresses the important desired (benefits) and undesired (harms) pharmacotherapy outcomes for patients. Outcomes of critical decision‑making included percent of total body weight loss (TBWL), proportion of patients achieving &gt;5%, &gt;10%, and &gt;15% TBWL, discontinuations due to side effects, and serious adverse events. The mean difference of 3% of TBWL between adjunctive pharmacotherapy and lifestyle modification alone, or an absolute 5% of TBWL above the baseline, was considered as a minimal clinically important difference in the effectiveness of pharmacotherapy in the treatment of obesity that corresponded to important benefits for patients. The strength of evidence for all outcomes was assessed using the GRADE system, in which evidence from randomized clinical trials was interpreted as high‑certainty, and confidence in the evidence conveyed confidence in the effect estimates. For each outcome, the evidence was divided into 4 categories (high, moderate, low or very low). According to the GRADE approach, recommendations were marked as «strong» when the phrase «we recommend» was used, or «conditional» when the phrase «we suggest» was used. The guideline panel made 9 recommendations and strongly recommended the use of pharmacotherapy in addition to lifestyle intervention in adults with overweight and obesity who have an inadequate response to the lifestyle interventions. Four drugs have been approved by FDA for long‑term use in obesity: liraglutide 3.0 mg/day, semaglutide 2.4 mg/week, phentermine‑topiramate ER, and naltrexone‑bupropion ER. They are considered to have moderate to significant effects on weight loss and little or no harm, so these drugs have a positive balance in favor of their long‑term use. Unfortunately, the last three drugs are not registered in Ukraine.

Remote Treatment Successfully Delivers a Usual Care Weight Loss and Lifestyle Intervention in Adults with Morbid Obesity

Introduction: Remote delivery of behavioral and lifestyle interventions has shown a great potential for achieving weight loss comparable to in-person treatment. However, little is known about its effects on adherence and efficacy in a real-world setting. During the COVID-19 pandemic, our usual care, a 12-month treatment program for morbid obesity, had to be transitioned to remote delivery. We evaluated whether this had adverse effects on weight loss or adherence. Methods: We report retrospective data of 234 patients who belonged either to a cohort affected by the transition of treatment delivery (N = 117, mean age = 44.2 years; BMI = 47.7 kg/m²) or to an individually matched control group treated prior to the pandemic (N = 117, 44.4 years; 47.3 kg/m²). Weight loss, dropouts, and attendance were compared between both groups and between remote and regular treatment periods. Results: Weight loss and the number of dropouts did not differ between the two groups and between treatment periods. However, attendance at remotely offered meetings was lower in the pandemic group (72.5%) when compared to the same meetings offered face to face in the control group (81.0%, p < 0.001). Discussion/Conclusion: Usual care weight loss and lifestyle interventions for morbid obesity can be successfully delivered via remote treatment.

551-P: Effects of a Plant-Based Intensive Lifestyle Intervention in Adults with Type 2 Diabetes: A Randomized Controlled Trial

Background: The Republic of the Marshall Islands (RMI) has the highest rate of type 2 diabetes (T2D) in the world. Lifestyle interventions, including plant-based diets and exercise, have been shown to effectively manage T2D. Objective: We therefore conducted the largest plant-based lifestyle intervention in adults with T2D. The goal of this study was to determine whether a plant-based lifestyle intervention is more effective than the standard of care for treating type 2 diabetes. Methods: We conducted a parallel-arm randomized clinical trial in Majuro, RMI. Adults with T2D were randomized to either standard of diabetes care (SOC) or a plant-based lifestyle intervention (PB+Ex) for 24 weeks. The first 12 weeks of the intervention involved the provision of plant-rich meals, counselling, cooking classes, and group exercise sessions, which gradually decreased in frequency over the 12-week period. Thereafter, from Weeks 13-24, participants in the PB+Ex group were instructed to continue the lifestyle intervention on their own. The primary outcome was change in HbA1c. Secondary outcomes included fasting glucose, insulin, blood pressure, lipids, and medication use. Outcome data was collected at five time points and analyzed using linear mixed models. Results: One hundred thirty-eight adults with T2D started the intervention (mean ± SD; age: 54.3 ± 8.6 years, HbA1c: 10.3 ± 2.1%; 50.7% female) . PB+Ex reduced HbA1c by 1.3 ± 0.3% (lsmean ± SEM; p&amp;lt;0.001) and 0.7 ± 0.3% (p=0.01) at weeks 12 and 24, respectively, compared to SOC. PB+Ex also decreased BMI at weeks 12 and 24 (both -1.1 kg/m2; p&amp;lt;0.001) . Additionally, PB+Ex reduced C-reactive protein and waist circumference compared to SOC. Additional analyses on other fasting cardiometabolic endpoints and medication changes are underway. Conclusions: A plant-based intensive lifestyle intervention with exercise is more effective at improving glycemic control, BMI, and inflammatory markers than the standard of diabetes care. Disclosure C.Hanick: None. C.M.Peterson: None. J.Sabaté: None. B.C.Davis: None. J.W.Spence: None. J.Kelly: None. Funding Department of the Army (W81XWH-05-1-0547)

Lifestyle Interventions for Adults with Infertility.

With a significant increase in the age-standardized prevalence of infertile men and women, infertility has become a widespread global issue. Furthermore, infertility has led to increased stigma and disease burden. The causes of infertility include lifestyle factors such as obesity, an unbalanced diet, and physical activity. To increase the rate of successful pregnancy, infertile men and women must improve their health and fertility through lifestyle improvements.

Cardiovascular effects of intensive lifestyle intervention in adults with overweight/obesity and type 2 diabetes according to body weight time in range.

SummaryBackgroundWe aimed to assess whether the cardiovascular effects of intensive lifestyle intervention (ILI) vary for those who can maintain the lower body weight after weight loss through ILI.MethodsIn the secondary analysis of the Look AHEAD trial, we identified the status of weight loss for the participants in the ILI arm based on body weight time in range (TIR). These participants were allocated to three groups according to body weight TIR: 0% (n = 727), >0% to 50% (n = 656), and >50% to 100% (n = 811). For each group, cardiovascular outcomes were compared with matched participants receiving diabetes support & education (DSE) using 1:1 propensity score matching and Cox regression.FindingsDuring a median of 9·5 years of follow-up, participants with TIR of >50% to 100% can effectively maintain their body weight after weight loss through ILI; participants with TIR of 0% or >0% to 50% do not achieve or maintain weight loss. Compared with the corresponding matched participants in the DSE arm, participants with TIR of >50% to 100% in the ILI arm had a 45% lower risk of the primary outcome (HR 0·55, 95% CI 0·40–0·76), and no significant effects were found on the risk of the primary outcome in participants with TIR of 0% (HR 1·12, 95% CI 0·86–1·46) or >0% to 50% (HR 1·14, 95% CI 0·85–1·52).InterpretationIn adults with overweight/obesity and type 2 diabetes, ILI might help in lowering the risk of cardiovascular events when the lower body weight is maintained after weight loss.FundingNone.

Efficacy of lifestyle intervention in adults with impaired glucose tolerance with and without impaired fasting plasma glucose: A post hoc analysis of Da Qing Diabetes Prevention Outcome Study.

The extent that pre-diabetic fasting plasma glucose (FPG) levels influence the effectiveness of lifestyle interventions in preventing type 2 diabetes (T2DM) is uncertain. We aimed to determine if the outcome of lifestyle intervention in people with impaired glucose tolerance (IGT) differs in those with normal or impaired FPG levels. Data were used from the Da Qing Diabetes Prevention Outcome Study, which was a 30-year follow-up of a 6-year randomized trial of lifestyle intervention in 576 people with IGT. We then conducted a post-hoc analysis to compare the efficacy of intervention to reduce the incidence of T2DM and its complications in those with baseline FPG <100 mg/dL and FPG ≥100 mg/dL. Lifestyle intervention reduced the cumulative incidence of T2DM by 37%-46% in those with baseline FPG <100 mg/dL and by 47%-51% in those with FPG ≥100 mg/dL. The FPG <100 mg/dL group had a lower cumulative incidence of diabetes and 6.41 years median delay in its onset compared with 2.21 years delay in the FPG ≥100 mg/dL group. In those with FPG <100 mg/dL intervention was associated with at least as great a reduction in cardiovascular disease and all-cause mortality as in the FPG ≥100 mg/dL group. Lifestyle intervention reduced the incidence of T2DM in people with IGT regardless of baseline FPG levels, and in those with FPG <100 mg/dL led to a substantial delay in its onset. All persons with IGT, with normal or impaired FPG levels, may benefit from lifestyle intervention to delay its onset and mitigate the incidence of T2DM.

Abstract 14192: Breakfast Consumption is Associated With Weight Loss During an Intensive Lifestyle Intervention for Adults With Overweight/Obesity and Type 2 Diabetes: Results From the Look AHEAD Trial

Background: Breakfast skipping is linked to obesity and related cardiometabolic outcomes in observational studies, but the association between breakfast eating and weight loss is not well-established. We examined if weight loss outcomes in Look AHEAD were related to breakfast consumption frequency (BCF). Methods: We included a subset of participants (n=3862) from the public access dataset of Look AHEAD, an RCT that compared intensive lifestyle intervention (ILI) to diabetes support and education (DSE) control in adults with overweight/obesity and type 2 diabetes. A self-reported questionnaire collected BCF over a 7-day week annually. This value (0-7) was averaged across 4 years of the intervention to calculate an average BCF. We used robust multivariable linear regression analysis to estimate the association between % weight change and 4-year average BCF controlling for baseline sociodemographics, BMI, and diabetes-related variables. In separate models, we adjusted for self-reported caloric intake (n=880) and self-reported physical activity level (n=735) among those with data. Results: 4-year average BCF was similar in DSE (n=1914) and ILI (n=1948) arms, with a median of 7 days (IQR 6-7) for both arms (p=0.11). Each 1 day increase in average BCF was associated with an additional 0.43% weight loss in the ILI arm (p=0.002) but not in the DSE arm (β-coefficient 0.04% weight loss; p=0.73; p-interaction for arm x BCF=0.01). This association in the ILI arm remained significant after adjustment for daily caloric intake (p=0.04) but not after adjustment for physical activity (p=0.16). Conclusions: Breakfast consumption was associated with greater weight loss in subjects who received ILI, which was attenuated after adjustment for caloric intake and physical activity. To optimize weight loss interventions, the relationship between breakfast consumption and other weight loss behaviors should be further explored.

Within-Trial Cost-Effectiveness of a Structured Lifestyle Intervention in Adults With Overweight/Obesity and Type 2 Diabetes: Results From the Action for Health in Diabetes (Look AHEAD) Study.

To assess the cost-effectiveness (CE) of an intensive lifestyle intervention (ILI) compared with standard diabetes support and education (DSE) in adults with overweight/obesity and type 2 diabetes, as implemented in the Action for Health in Diabetes study. Data were from 4,827 participants during their first 9 years of study participation from 2001 to 2012. Information on Health Utilities Index Mark 2 (HUI-2) and HUI-3, Short-Form 6D (SF-6D), and Feeling Thermometer (FT), cost of delivering the interventions, and health expenditures was collected during the study. CE was measured by incremental CE ratios (ICERs) in costs per quality-adjusted life year (QALY). Future costs and QALYs were discounted at 3% annually. Costs were in 2012 U.S. dollars. Over the 9 years studied, the mean cumulative intervention costs and mean cumulative health care expenditures were $11,275 and $64,453 per person for ILI and $887 and $68,174 for DSE. Thus, ILI cost $6,666 more per person than DSE. Additional QALYs gained by ILI were not statistically significant measured by the HUIs and were 0.07 and 0.15, respectively, measured by SF-6D and FT. The ICERs ranged from no health benefit with a higher cost based on HUIs to $96,458/QALY and $43,169/QALY, respectively, based on SF-6D and FT. Whether ILI was cost-effective over the 9-year period is unclear because different health utility measures led to different conclusions.

Intervention Enhancement Strategies Among Adults With Type 2 Diabetes in a Very Low–Carbohydrate Web-Based Program: Evaluating the Impact With a Randomized Trial

BackgroundAdults with type 2 diabetes may experience health benefits, including glycemic control and weight loss, from following a very low–carbohydrate, ketogenic (VLC) diet. However, it is unclear which ancillary strategies may enhance these effects.ObjectiveThis pilot study aims to estimate the effect sizes of 3 intervention enhancement strategies (text messages, gifts, and breath vs urine ketone self-monitoring) that may improve outcomes of a 12-month web-based ad libitum VLC diet and lifestyle intervention for adults with type 2 diabetes. The primary intervention also included other components to improve adherence and well-being, including positive affect and mindfulness as well as coaching.MethodsOverweight or obese adults (n=44; BMI 25-45 kg/m2) with type 2 diabetes (glycated hemoglobin [HbA1c] ≥6.5%), who had been prescribed either no glucose-lowering medications or metformin alone, participated in a 12-month web-based intervention. Using a 2×2×2 randomized factorial design, we compared 3 enhancement strategies: (1) near-daily text messages about the intervention’s recommended behaviors (texts n=22 vs no texts n=22), (2) mailed gifts of diet-relevant foods and cookbooks (6 rounds of mailed gifts n=21 vs no gifts n=23), and (3) urine- or breath-based ketone self-monitoring (urine n=21 vs breath n=23). We assessed HbA1c and weight at baseline and at 4, 8, and 12 months. We evaluated whether each strategy exerted a differential impact on HbA1c and weight at 12 months against an a priori threshold of Cohen d of 0.5 or greater.ResultsWe retained 73% (32/44) of the participants at 12 months. The intervention, across all conditions, led to improvements in glucose control and reductions in body weight at the 12-month follow-up. In intent-to-treat (ITT) analyses, the mean HbA1c reduction was 1.0% (SD 1.6) and the mean weight reduction was 5.3% (SD 6.0), whereas among study completers, these reductions were 1.2% (SD 1.7) and 6.3% (SD 6.4), respectively, all with a P value of less than .001. In ITT analyses, no enhancement strategy met the effect size threshold. Considering only study completers, 2 strategies showed a differential effect size of at least a d value of 0.5 or greaterConclusionsText messages, gifts of food and cookbooks, and urine-based ketone self-monitoring may potentially enhance the glycemic or weight loss benefits of a web-based VLC diet and lifestyle intervention for individuals with type 2 diabetes. Future research could investigate other enhancement strategies to help create even more effective solutions for the treatment of type 2 diabetes.Trial RegistrationClinicalTrials.gov NCT02676648; http://clinicaltrials.gov/ct2/show/NCT02676648

Different Lifestyle Interventions in Adults From Underserved Communities: The FAMILIA Trial

BackgroundThe current trends of unhealthy lifestyle behaviors in underserved communities are disturbing. Thus, effective health promotion strategies constitute an unmet need. ObjectivesThe purpose of this study was to assess the impact of 2 different lifestyle interventions on parents/caregivers of children attending preschools in a socioeconomically disadvantaged community. MethodsThe FAMILIA (Family-Based Approach in a Minority Community Integrating Systems-Biology for Promotion of Health) study is a cluster-randomized trial involving 15 Head Start preschools in Harlem, New York. Schools, and their children’s parents/caregivers, were randomized to receive either an “individual-focused” or “peer-to-peer–based” lifestyle intervention program for 12 months or control. The primary outcome was the change from baseline to 12 months in a composite health score related to blood pressure, exercise, weight, alimentation, and tobacco (Fuster-BEWAT Score [FBS]), ranging from 0 to 15 (ideal health = 15). To assess the sustainability of the intervention, this study evaluated the change of FBS at 24 months. Main pre-specified secondary outcomes included changes in FBS subcomponents and the effect of the knowledge of presence of atherosclerosis as assessed by bilateral carotid/femoral vascular ultrasound. Mixed-effects models were used to test for intervention effects. ResultsA total of 635 parents/caregivers were enrolled: mean age 38 ± 11 years, 83% women, 57% Hispanic/Latino, 31% African American, and a baseline FBS of 9.3 ± 2.4 points. The mean within-group change in FBS from baseline to 12 months was ∼0.20 points in all groups, with no overall between-group differences. However, high-adherence participants to the intervention exhibited a greater change in FBS than their low-adherence counterparts: 0.30 points (95% confidence interval: 0.03 to 0.57; p = 0.027) versus 0.00 points (95% confidence interval: −0.43 to 0.43; p = 1.0), respectively. Furthermore, the knowledge by the participant of the presence of atherosclerosis significantly boosted the intervention effects. Similar results were sustained at 24 months. ConclusionsAlthough overall significant differences were not observed between intervention and control groups, the FAMILIA trial highlights that high adherence rates to lifestyle interventions may improve health outcomes. It also suggests a potential contributory role of the presentation of atherosclerosis pictures, providing helpful information to improve future lifestyle interventions in adults.

Abstract P113: The Primordial Prevention Project: Pilot Study of Disclosing Child’s Diabetes Genetic Risk Information

The prevalence of type 2 diabetes (T2D) in children has risen dramatically. NHANES data of 12-19 years old showed a significant increase, from 9% to 23%, in pre-diabetes and diabetes from 1999-2008, which was related to increases in BMI. Lifestyle interventions in adults have been shown to be effective at reducing T2D risk, however, interventions in families have been inconclusive in demonstrating the benefit of lifestyle change in reducing T2D risk. We hypothesized that using child’s genetic risk information in families at high risk of developing T2D would serve as a motivator to improve behaviors related to risk factors for T2D. We conducted a pilot study of 44 families and their children aged 2-8 who consented to participate in baseline, risk-disclosure and 3-month follow-up sessions. We identified families as high risk based on a maternal history of gestational diabetes, large for gestational age, or paternal obesity. Parents were surveyed on their family’s physical activity and dietary behaviors, and attitudes and motivations for lifestyle change at baseline and 3-month follow-up. At baseline, saliva samples were collected from children for genotyping of variants previously associated with obesity and T2D risk in genome-wide association studies. When genotyping was completed families were then scheduled to receive results. Parents completed questionnaires related to their anxiety (STAI-State) and depressive symptoms (POMS) prior to receiving their child’s genetic risk and immediately after the intervention. Parents received their child’s genetic risk report, in combination with a quasi-motivational interviewing session and educational materials. At the end of the session parents set individualized behavior goals for themselves and their children based on their responses to baseline questionnaires related to dietary and PA behaviors. Follow-up at 3 months are still being collected. Results from the risk disclosure session are reported here. Parents were 35±5 years old; 11% Latino, 26% black and 63% White; and 60% were mothers. Parents reported a significant increase in fatigue (ß =0.98, p=0.001), depressiveness (ß=0.35, p=0.04), and anxiety (ß =3.0, p=0.001) from pre-risk disclosure compared to post risk-disclosure. Parents reported a significant increase in their confidence to change their family’s behaviors after receiving the intervention (ß=0.34, p=0.001). All parents committed to a personalized health behavior change after learning of their child’s risk. In conclusion, we were able to demonstrate that genetic risk may be a useful motivator to encourage parents to take immediate action to make improvements to their family’s health behaviors. Short-term follow-up results will determine whether changes were meaningful in actual behavior changes.

One-year effects of a group-based lifestyle intervention in adults with type 2 diabetes: A randomized encouragement trial

AimsTo estimate the real-world effects of offering a group-based lifestyle intervention (GLI) to adults with diabetes. MethodsThis randomized encouragement trial included adult primary care patients in metropolitan Chicago with type 2 diabetes and body mass index ≥24 kg/m2. Participants were randomized to standard care (brief dietary and lifestyle counseling) or standard care plus being encouraged, but not required, to participate in a free-of-charge GLI offered by the YMCA. The GLI was a group-based adaptation of the Look AHEAD lifestyle intervention. ResultsOf 331 participants, 167 were randomized to standard care and 164 to the GLI encouragement arm. About one third of participants were non-Hispanic White (34.4%). In the GLI arm, 75 (45.7%) attended ≥1 GLI visits. In the primary intention-to-treat analysis, the effect of GLI encouragement was 0.95% weight loss at six months (95% confidence interval [CI], 0.13–1.77%; P = 0.02), and 1.20% weight loss at 12 months (95% CI, 0.05–2.36%; P = 0.04). At 12 months, there was a 0.30% (3.3 mmol/mol) reduction in hemoglobin A1c, but this result did not achieve statistical significance (P = 0.054). In instrumental variable analysis estimating effects among the subgroup of participants who attended any GLI visits, the effect of GLI attendance was 2.30% weight loss at six months (95% CI, 0.30–4.30%; P = 0.02), and 2.07% weight loss at 12 months (95% CI, 0.25–3.88%; P = 0.02). We detected no significant blood pressure or cholesterol effects. ConclusionsAmong adults with type 2 diabetes, a group-based lifestyle intervention in a community-based setting achieved modest weight loss at 6 and 12 months.Clinical trial registration: ClinicalTrials.gov Identifier NCT01435603.

Lifestyle Intervention for Adults With Spinal Cord Injury: The USC–RLANRC Pressure Ulcer Prevention Study

Abstract Date Presented 4/1/2017 We tested an occupational therapy intervention designed to prevent medically serious pressure ulcers (MSPrUs) in 232 adults with spinal cord injury. MSPrU rates did not differ between the intervention and control groups. The intractable nature of the ulcer threat and lack of power may have contributed to the null result. Primary Author and Speaker: Florence Clark Contributing Authors: Jeanine Blanchard, Cheryl Vigen, Michael Carlson

Lifestyle intervention for adults with spinal cord injury: Results of the USC–RLANRC Pressure Ulcer Prevention Study

Context/Objective: Medically serious pressure injuries (MSPrIs), a common complication of spinal cord injury (SCI), have devastating consequences on health and well-being and are extremely expensive to treat. We aimed to test the efficacy of a lifestyle-based intervention designed to reduce incidence of MSPrIs in adults with SCI. Design: A randomized controlled trial (RCT), and a separate study wing involving a nonrandomized standard care control group. Setting: Rancho Los Amigos National Rehabilitation Center, a large facility serving ethnically diverse, low income residents of Los Angeles County. Participants: Adults with SCI, with history of one or more MSPrIs over the past 5 years: N=166 for RCT component, N=66 in nonrandomized control group. Interventions: The Pressure Ulcer Prevention Program, a 12-month lifestyle-based treatment administered by healthcare professionals, largely via in-home visits and phone contacts. Outcome Measures: Blinded assessments of annualized MSPrI incidence rates at 12 and 24 months, based on: skin checks, quarterly phone interviews with participants, and review of medical charts and billing records. Secondary outcomes included number of surgeries and various quality-of-life measures. Results: Annualized MSPrI rates did not differ significantly between study groups. At 12 months, rates were .56 for intervention recipients, .48 for randomized controls, and .65 for nonrandomized controls. At follow-up, rates were .44 and .39 respectively for randomized intervention and control participants. Conclusions: Evidence for intervention efficacy was inconclusive. The intractable nature of MSPrI threat in high-risk SCI populations, and lack of statistical power, may have contributed to this inability to detect an effect. Trial Registration: ClinicalTrials.gov NCT01999816

Lifestyle interventions for adults with impaired glucose tolerance: a systematic review and meta-analysis of the effects on glycemic control.

Previous meta-analyses have demonstrated that lifestyle modification can reduce the blood glucose levels in patients with type 2 diabetes, although the effects of changes in the blood glucose level on impaired glucose tolerance (IGT) remain controversial. This review therefore aimed to determine the efficacy of lifestyle interventions in adults with IGT. We searched the Medline, Cochrane Library, EMBASE and Science Citation Index databases and reference lists of the included articles. Two independent reviewers extracted the data and assessed the quality of the included studies; a total of nine randomized controlled trials met the inclusion criteria. In addition, we tested for trial heterogeneity and calculated the pooled effects size using the random effects model. The overall interventions were associated with a decline in the 2-hour plasma glucose levels [standardized mean differences (SMD) -0.56; 95% confidence interval (CI), -1.01 to -0.10; I(2), 96.6%]. Moreover, dietary intervention (SMD -0.53; 95% CI -0.77 to -0.28) and physical intervention (SMD -0.42; 95% CI -0.63 to -0.20) were each associated with a decline in the 2-hour plasma glucose levels compared with that observed in the control participants. The overall interventions were associated with a decline in the fasting plasma glucose (FPG) levels (SMD -0.27; 95% CI -0.38 to -0.15; I(2) = 47.1%). In addition, physical intervention (SMD -0.25; 95% CI -0.44 to -0.05) and combined dietary and physical intervention were each associated with a decreased FPG level (SMD -0.28; 95% CI -0.44 to -0.12) compared with that observed in the control participants. Lifestyle modification based on physical or dietary interventions or both is associated with improvements in the 2-hour plasma glucose and FPG levels in IGT patients.

Increase in Daily Steps After an Exercise Specialist Led Lifestyle Intervention for Adults with Type 2 Diabetes in Primary Care: A Controlled Implementation Trial

Increase in Daily Steps After an Exercise Specialist Led Lifestyle Intervention for Adults with Type 2 Diabetes in Primary Care: A Controlled Implementation Trial

Cancer Risk Factors Among Adults with Serious Mental Illness

Background There is strong evidence to suggest that adults living with serious mental illness have a higher risk of mortality and morbidity than the general U.S. population, including a higher risk of mortality associated with certain cancers and cancer-related deaths. The potential loss of life expectancy among this population may be as high as 25 years compared to those without a mental illness. There are numerous challenges faced by people with serious mental illness, and behavioral factors that may contribute to increased cancer risk, including high prevalence of smoking, obesity, physical inactivity, substance abuse, and infectious diseases. Many of these individuals are uninsured, homeless, have a dual diagnosis of substance abuse, and are least likely to access and use preventive healthcare services. There is growing concern that those with serious mental illness experience disparities in health education, health prevention services, cancer screening, access to diagnostic testing, cancer case recognition, and higher cancer case fatalities. Although there are many interrelated and complex factors associated with cancer-related risk among this vulnerable population, many of these factors can be addressed. This paper aims to increase awareness of cancer risk factors and implications of employing innovative health promotion and cancer-prevention strategies among people with serious mental illness.