ADA 2010: Community-based lifestyle program helps overweight/obese shed pounds, lower blood glucose

A community-based behavioral lifestyle intervention results in significant reductions in glycated hemoglobin, fasting blood glucose, and body weight in overweight/obese individuals with prediabetes, said David Goff Jr, MD, PHD.

The intervention is managed by registered dietitians (RDs) or certified diabetes educators (CDEs) but delivered by community health workers who are trained by the RDs and CDEs, with further support from digital video discs. The program is similar to the Diabetes Prevention Program, which was conducted in 27 centers around the United States but applied in a community setting.

In the Healthy Living Partnerships to Prevent Diabetes (HELP-PD) study, 301 overweight/obese adults 21 years old or older (body mass index [BMI] of 25 to 40 kg/m²) who had 2 fasting glucose levels of 95 to 125 mg/dL were randomized to the intervention or usual care. The goals of the intervention were a calorie deficit of 500 to 1,000 calories per day and 180 minutes of activity per week introduced gradually to affect a weight loss to 1 to 2 lb per week and a 7% loss of body weight by 1 year.

The intervention group underwent a 6-month intensive phase of education and meetings with community health workers. The usual care group received 2 sessions with an RD during the first 3 months and monthly newsletters about community resources for weight loss.

Three-fourths of the study population was white; one-fourth was black. The average fasting glucose value at baseline was 105.5 mg/dL. Findings at 12 months were:

• The intervention group lost 7.1 kg of body weight, and the usual care group lost 1.5 kg (P
• The intervention group lost 7.3% of body weight, and the usual care group lost 1.3% (P
• BMI decreased by 2.2 kg/m2 in the intervention group and by 0.3 kg/m2 in the usual care group (P
• Waist circumference declined by 5.9 cm in the intervention group and 0.8 cm in the usual care group (P
• Fasting glucose level dropped by 4.2 mg/dL in the intervention group and 0.3 mg/dL in the usual care group (P
• Fasting insulin fell by 6.6 uU/mL in the intervention group and by 2.7 uU/mL in the usual care group (P

“We believe that a 4 mg/dL reduction in glucose is clinically meaningful,” said Goff, professor of public health sciences and internal medicine, Wake Forest University.

As ascertained by a single measure of blood glucose, 2 participants in the intervention group progressed to diabetes at month 12 compared with 7 in the usual care group.

The trial is ongoing. “The effects during the second year and beyond and the economic impact are still to be determined,” Goff said.