Technology-based self-monitoring may be effective for type 2 diabetes, CKD weight loss
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Technology-based self-monitoring showed a “strong and significant intervention effect for weight loss” over 3 months in patients with type 2 diabetes and chronic kidney disease, according to a study published in Journal of Renal Nutrition.
“It is generally accepted that education alone is insufficient for engaging most people in lifestyle behavior change, and that theory-based approaches targeting psychological determinants of behavior (eg, attitudes, risk perceptions, and self-efficacy) are necessary,” David E. St-Jules, RD, PhD, and colleagues wrote. “But even the most highly motivated patients may have difficulty with multiple behavior changes because of information complexity. In this trial we evaluated the main and interaction effects of behavioral counseling vs. a technology-based self-monitoring intervention designed to reduce information processing burden.”
In a 2x2 factorial, randomized controlled trial, 256 patients 40 years or older with type 2 diabetes, CKD and a BMI of at least 27 kg/m2 were studied. Participants were divided into four groups to observe the effects of social cognitive theory-based behavioral group counseling (SCT), technology-based self-monitoring (MONITORING) and their interaction (COMBINED) to baseline advice (ADVICE) concerning the study’s primary outcomes of weight loss, physical activity and intake of sodium and phosphate additives.
Methods for each treatment group
The study period lasted 6 months, with measurements taken at baseline, 3 months and 6 months. Participants in every group had an identical prescription for diet and physical activity to achieve the target of 5% or more baseline body weight loss: energy intake goal of 500 kcal/day deficit, moderate-intensity physical activity for 150-minutes/week, less than 1,500 mg/day of sodium, and staying away from foods with phosphorus-based additives.
Those in the ADVICE treatment group received one-page educational handouts in the mail that defined ways they could achieve the intervention measurement targets at 3 and 6 months. Participants in the MONITORING, SCT and COMBINED groups were given an iPad with a 4G data plan that included a videoconferencing platform for group sessions with a dietitian and MyNetDiary to log their food and beverage intake, as well as physical activity and body weight.
Behavior change results were recorded through clinical measurements, physiologic measurements, blood samples and urine samples.
Treatment groups and weight loss
Researchers randomized 256 participants, but only 186 (73%) finished 6-month assessments. In the SCT, MONITORING and COMBINED treatment groups, participants took part in three-quarters of the intervention sessions and demonstrated comparable attendance rates. In both the MONITORING and COMBINED groups, the use of MyNetDiary to record food varied substantially between individuals; however, there were no between-group differences found.
Follow-up from participants in the ADVICE group decreased from 3 months to 6 months (30-40% vs. 20-30%).
Overall, the number of participants meeting the weight loss target at 3 months was relatively small, but the MONITORING group had greater weight loss than the ADVICE (P = 0.4) and SCT (P = .02) groups. When adjusted for multiple comparisons, these differences in weight loss were not significant for this intervention period and did not continue in 6 months.
Data across groups were joined together to compare the main effects of SCT vs. no SCT and MONITORING vs. no MONITORING because the COMBINED group showed no benefit.
No significant differences in weight changes at 3 or 6 months were found in SCT group, but they were found in MONITORING vs. no MONITORING groups at 3 months (P = .02). In both MONITORING and NON-MONITORING groups, weight loss was faster during the 0- to 3-month period, and MONITORING participants showed faster weight loss rates then NON-MONITORING participants (P = .02) during this interval.
Adjusting for multiple comparisons yielded no significant differences in secondary outcomes.
Researchers reported that at both 3 and 6-monthss, mean weight losses in every group were less than what is commonly deemed clinically significant.
“Behavioral counseling alone was no better than baseline advice and demonstrated no interaction effect with self-monitoring,” St-Jules and colleagues wrote. “Behavioral counseling may be important for sustaining longer-term behavior change (eg, beyond 6 months), but must be confirmed with additional research. Future studies would be strengthened by selecting participants who are obese; have more advanced CKD but no apparent nutritional risk and/or multiple cardiorenal risk factors, including more in-person intervention contacts, enhancing retention incentives, and simplifying collection of urinary samples.”
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