This article is more than 5 years old. Information may no longer be current.
Intensive lifestyle intervention improves body weight, glucose profile in Hispanic women
Hispanic women with prediabetes randomly assigned to 14 weeks of intensive lifestyle intervention, including cooking demonstrations and group grocery store trips, saw a significant decrease in body weight, waist circumference and fasting insulin at 1 year vs. women assigned to usual care, according to recent findings.
Michelle A. Van Name, of the division of pediatric endocrinology at Yale University School of Medicine, and colleagues analyzed data from 130 women (90% Hispanic) randomly assigned intensive lifestyle intervention (n = 65; mean age, 44 years; mean BMI, 35.4 kg/m²) or usual care (n = 65; mean age, 43 years; mean BMI, 35.2 kg/m²).
Intervention included 1-hour, weekly group programs led by a bilingual nurse practitioner and held at a public school near the health center, focusing on healthy food choices, behavior changes and weight loss. The group program was enhanced to include weekly cooking demonstrations, group learning lessons at a local grocery store and encouragement to participate in the neighborhood community farm. A parallel program of play-based physical activity for participants’ children was offered simultaneously at the school.
Participants assigned to usual care received one session of diabetes prevention counseling by a study staff member who recommended they lose 7% of their body weight and increase physical activity by 150 minutes per week. All participants underwent an oral glucose tolerance test at baseline and 12 months and contributed blood samples before and after ingesting oral glucose to measure plasma glucose levels.
At 12 months, the intervention group lost a mean of 3.8 kg (4.4%); the usual care group gained 1.4 kg (1.6%; P < .0001). Two-hour glucose excursion decreased 15 mg/dL in the intervention group vs. 1 mg/dL in the usual care group (P = .03). Researchers noted significant decreases favoring the intervention group for BMI, percent body fat, waist circumference and fasting insulin.
“The [intervention] was enthusiastically received by most of the subjects and achieved clinically and statistically significant changes in body weight and BMI over 12 months in these patients with prediabetes,” the researchers wrote. “The 5.2-kg (6%) difference in body weight between the two groups at 12 months was greater than we anticipated and, if sustained, would be expected to delay or reduce the risk for developing type 2 diabetes.” – by Regina Schaffer
Disclosure: One of the researchers reports serving as a consultant for AstraZeneca, Medtronic, Novo Nordisk, Sanofi, Takeda and Unomedical.
Perspective
Back to Top
Since the results of the Diabetes Prevention Program (DPP) were published in 2002, researchers and public health practitioners across the U.S. have been working to translate the program’s highly successful lifestyle intervention from the clinical trial setting to the real world. The challenges in doing this are well-known — the real world does not generally provide the same resources that are available to clinical trials for implementing such interventions, thus modifications to allow for delivery in different settings and to a variety of populations with an eye toward lowering cost are necessary. The concern is that in making such feasibility and cost-saving adaptations, the intervention may be watered down and results may not be comparable to original trial findings.
The current study by Van Name and colleagues (above) is an example of a real-world adaptation of the DPP for a specific population. In this study, the DPP intervention was adapted for Hispanic women to include a family-focused group-delivered program consisting of 14 weekly core sessions (vs. the original DPP’s 16 core sessions followed by post-core maintenance), and provided in both English and Spanish at a local community health center.
While it is difficult to determine reduction in actual risk for diabetes in DPP translation studies due to funding constraints and generally small sample sizes, this study and many other similar studies, have suggested that the DPP intervention can be successfully adapted and delivered in the community setting in a cost-reducing manner.
The review by Neahmah and colleagues (at left) looked specifically at studies that have documented modifications made to the DPP lifestyle intervention for translation to the real world, as well as the outcomes reported. Their findings support the concept that adapted versions of the DPP are being successfully and effectively offered in a variety of community settings, by a diverse group of providers, and for many populations. However, while feasibility and cost-limiting modifications to the DPP curriculum do not seem to have an ill effect, the authors caution that programs that remained closer to the original DPP model appeared to have better results, so fidelity to the original intervention remains important. In addition, it is important for program planners to include a “maintenance” component in the intervention whenever possible. The findings of the review should be encouraging to practitioners who are planning to implement an adapted DPP lifestyle intervention in their community.