PHILADELPHIA—A program in which primary care staff counsel patients with metabolic syndrome by telephone using the Diabetes Prevention Program (DDP) lifestyle intervention produces significant weight loss, according to results released at the 72nd Scientific Sessions of the American Diabetes Association.
The data, from the Support, Health Information, Nutrition and Exercise (SHINE) study, also show that the benefits are similar whether the counseling is provided in a one-on-one or group conference call. The intervention used in the study was drawn from the landmark DPP study, which found that weight loss following intense counseling about dietary changes and increased physical activity delayed or prevented diabetes in individuals at high-risk because of pre-diabetes.
“What we have shown in a diverse population—many of whom were low-income—is that you can train personnel from primary care offices to deliver the program, you can use the telephone which extends outreach, and it can be effective in helping people lose weight, which can help decrease their risk of developing diabetes and related complications,” said Ruth S. Weinstock, MD, PhD, Distinguished Service Professor at SUNY Upstate Medical University at Syracuse and Chief of the Division of Endocrinology, Diabetes, and Metabolism.
The study included individuals aged 18 years or older who were in stable health and had metabolic syndrome defined by International Diabetes Federation (IDF) criteria, a body mass index of 30 kg/m2 or greater, and no diabetes. Investigators randomized subjects to receive the DPP lifestyle change program by a one-on-one counseling or by a group conference call.
“The DPP program was conducted in academic centers and was very resource-intensive, and we hoped to be able to translate the program into one that was more widely available and less costly,” Dr. Weinstock explained. “We thought that it made sense to test the program in the primary care setting because we felt that it would be an advantage for people to be able to access the program through their primary care provider.”
The investigators also believed that delivering the program via the telephone might help extend reach.
The 16-session DPP curriculum was delivered over one year at five diverse primary care practices by trained staff—either medical office assistants or nurses—that had been selected by the primary care physician. Study participants underwent once-weekly telephone counseling with staff for the first five weeks and then monthly thereafter. A dietitian was available for up to 11 telephone counseling sessions.
Results at one year were available for 114 individuals who received the solo intervention and 123 individuals who received the group intervention. Solo treatment participants had a mean weight loss of 4.6 kg compared with 6.0 kg for group treatment participants. Both groups had a 2 kg/m2 decrease in body mass index. Waist circumference decreased by 5.1 cm in the solo intervention group compared with 6.0 cm in the group treatment participants. The researchers found no significant differences in any of the clinical measures between the two treatment groups.
Additionally, the analysis demonstrated that 38.7% and 42.5% of solo and group participants, respectively, lost at least 5% of their baseline weight and that greater weight loss (7.1 kg) was achieved with participation in at least nine of 16 core sessions.
Dr. Weinstock said that study participants will be followed for an additional two years and that future analyses will examine the effect of telephone delivery of the DPP program on fasting glucose, lipids, blood pressure, physical activity, psychosocial outcomes, and cost-effectiveness.