Endocrine Abstracts

Aim: To estimate the efficacy of structured lifestyle modification program on clinical and metabolic status in overweight/obese patients with type 2 diabetes (T2DM).

Materials and methods: The program was implemented in 2 centers (Moscow, Kazan) and 130 participants were recruited (100-active group, 30-control group). The patients’ characteristics in active group: mean age was 54.6±10.2 years, diabetes duration 6.6±5.6 years, BMI 34.4±3.5 kg/m², HbA_1C 7.4±1.7%. The patients’ characteristics in control group: mean age was 60.6±8.9 years, diabetes duration 11.2±8.5 years, BMI 33.5±3.5 kg/m², HbA_1C 7.8±1.9%. This program consisted of five components: dietary intervention; individualized exercise intervention; specific model of psychotherapeutic intervention (team coaching); group education and antidiabetic drug adjustment. Before the program patients underwent a comprehensive evaluation. Patients of active group attended the clinic once weekly for 3 hours (12 weeks). Group sessions were conducted each week by the endocrinologist, dietitian, psychologist and exercise physiologist (EP). The exercise plan included weekly 60-minute exercise session (in the 1-st month 30-minute) of aerobic, resistance and flexibility exercises under the supervision of EP. The components of team coaching were: goal setting, self-monitoring, stimulus control, attributive style modification, stress management and relapse prevention. During another 9 months, medical monitoring was carried out monthly. Medical parameters were measured at baseline, after 3 and 12 months.

Results: 90 participants of active group and 29 participants of control group completed the study. After 1 year 50% of active group and 13.3% of control group achieved the primary goal ≥5% of weight reduction from baseline (OR 6.54 (95% CI [2.01; 21.33], P=0.002). The weight loss ≥10% was achieved in 26 patients of active group and in two patients of control group (OR 12.09 (95% CI [1.41; 103.39], P=0.023). Mean weight loss was 5.6 kg (95% CI [−6.7; −4.4]) and 0.8 kg (95% CI [−2.1; 0.4]) in the active and control groups respectively. The reduction of waist-hip ratio (WHR) was 0.016 (95% CI [−0.023; −0.008]) in active group; WHR increased by 0.017 (95% CI [0.0076; 0.026]) in control group. HbA_1C decreased by 0.8% (95% CI [−1.1; −0.5]) and by 0.1% (95% CI [−0.5; 0.2]) in active and control groups respectively. 58.3% of active group achieved HbA_1C ≤7%. The mean difference of patients’ achieved HbA_1C ≤7% between groups was 58.3% (95% CI [30.2;80.6], P<0.001).

Conclusion: Structured weight management program in overweight/obese patients with T2DM showed high effectiveness in both the weight reduction and the improvement of glycemic control.