Study Shows Coaching Effective For Presymptomatic Disorder

Primary Source: Type 2 Diabetes Prevention in the “Real World” - One-year results of the GOAL Implementation Trial Pilvikki Absetz, PHD1, Raisa Valve, PHD2, Brian Oldenburg, PHD3, Heikki Heinonen, PHD1, Aulikki Nissinen, MD, PHD1, Mikael Fogelholm, SCD4, Vesa Ilvesmäki, MD, PHD5, Martti Talja, MD, PHD5 and Antti Uutela, PHD. Diabetes Care 30:2465-2470, 2007

Secondary Source & CME: Lifestyle Counseling Program May Help Reduce Risk of Developing Type 2 Diabetes¹

The Study

This article reports on 352 middle-aged participants with elevated type 2 diabetes risk enrolled in The Good Ageing in Lahti Region (GOAL) Lifestyle Implementation Trial² with lifestyle and risk reduction objectives derived from the major diabetes prevention efficacy trials. The intervention included six group counseling sessions, delivered by trained public health nurses. Measurement was conducted at baseline and 12 months. Clinical risk factors were measured by study nurses, and lifestyle outcomes were analyzed from self-reports. Lifestyle outcomes were compared with the outcomes achieved in relevant efficacy trials, and within-subject changes were tested for risk reduction.

Results, excerpted from the abstract, follow:

Commentary

While methodological problems, such as lack of randomization, use of unmasked study nurses, and recruitment among healthcare patients, limit the extension of the findings, the demonstration that patients who are at risk but asymptomatic for diabetes will comply with coaching interventions that can be economically delivered and scaled up as needed to change lifestyle habits is both impressive and heartening.

Footnotes

1. Lifestyle Counseling Program May Help Reduce Risk of Developing Type 2 Diabetes. News Author: Laurie Barclay, MD, CME Author: Désirée Lie, MD, MSEd. Release Date: October 2, 2007; Valid for credit through October 2, 2008. Credits Available: Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s)™ for physicians; Family Physicians - up to 0.25 AAFP Prescribed credit(s) for physicians [back]
2. This is a description of a real-world integrated program offered at 16 health centers in Finland in the GOAL project during a 1-year period. The program is a lifestyle implementation trial designed for primary care to assess the impact on behaviors and risk for diabetes during 12 months.
   Study Highlights

   * The GOAL program is a community health promotion program in an area in Finland covering 14 municipalities and a total of 208,000 inhabitants.
   * The education program was guided by 5 objectives: less than 30% intake from fat calories, less than 10% of total energy from saturated fat, at least 15 g of fiber per 1000 kcal, at least 4 hours per week of moderate-level physical activity, and more than 5% reduction in body weight.
   * The DPS had shown that attainment of at least 4 objectives led to a reduced risk for diabetes, and this was used as an outcome goal.
   * The educational model was group based and task oriented with use of counseling based on the Health Action Process Approach, a social-cognitive health behavior model.
   * Program sessions lasted 2 hours and were structured with information provision, group discussion, and self-monitoring of behavior.
   * Public health nurses delivered education, facilitating groups with support from dieticians.
   * The first 5 sessions occurred for 8 weeks with 2-week intervals, and the last session took place at 8 months.
   * Patients aged 50 to 65 years who had identified risk factors (obesity, hypertension, and elevated lipid or blood glucose levels) were recruited and were screened with a questionnaire.
   * A risk score of 12 or more (17%, 10-year risk for diabetes) based on the questionnaire was used to select 405 patients.
   * Excluded were patients with mental health problems and those who were diagnosed with type 2 diabetes, myocardial infarction in the past 6 months, or acute cancer.
   * 352 participants from 16 health centers were assigned to 36 groups for the intervention.
   * At 12 months, participants were mailed a questionnaire, had anthropometric measurements and laboratory blood tests, and completed a 3-day food diary.
   * Key lifestyle measures assessed at 12 months were total intakes of fat, saturated fat, and fiber; physical activity; and relative change in weight.
   * Secondary outcomes were change in risk from baseline to 12 months, waist circumference, blood pressure, and lipid and glucose levels.
   * Mean age was 58 years, two thirds had at least an elementary school education, 47% were retired, 70% were married or cohabiting, 70% were obese, 65% had normal glucose tolerance levels, and 30% of men and 21% of women had impaired glucose tolerance levels at baseline.
   * Mean waist circumference was more than 100 cm in women and 110 cm in men, and mean lipid and blood pressure levels were slightly elevated at baseline.
   * 57% of participants attended all 6 sessions, and attendance dropped from 90% by 5 sessions to 81% at the sixth session.
   * At 12 months, those who already met the 5 objectives at baseline were most likely to meet them.
   * 281 failed to meet 1 or more objectives.
   * 20% achieved at least 4 of 5 objectives.
   * Physical activity and weight loss were achieved significantly less frequently (65% vs 86% and 12% vs 43%, respectively).
   * Weight reduction was 1.5 kg in men and 0.5 kg in women, much lower than the 4.2 kg achieved in the DPS.
   * Program effects were stronger for men than for women.
   * Risk factors that decreased significantly in men were diastolic blood pressure, weight, and BMI.
   * Waist circumference decreased in both sexes.
   * There was an increase in impaired glucose tolerance levels for those with normal glucose tolerance levels at baseline but a decrease in those with baseline impaired glucose tolerance levels.
   * Among participants able to reach at least 4 objectives, 83% had normal glucose tolerance levels, 11% had impaired glucose tolerance levels, and 6% developed diabetes.
   * For those reaching 3 or fewer objectives, the respective rates were 73%, 25%, and 3%. [back]

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