Extended behavioral intervention suggested for optimal glycemic control
medwireNews: Obese adults with prediabetes may need a longer-than-recommended course of behavioral weight loss treatment to optimize improvements in glycemic control, US researchers report.
Michael Perri (University of Florida, Gainesville) and colleagues explain that clinical guidelines currently “recommend a moderate dose (16 weekly sessions) of behavioral weight loss treatment for adults with excess body weight.”
But their study found that although both moderate- and high-dose interventions resulted in significant weight loss relative to low-dose and control interventions, only the high-dose strategy led to significant reductions in glycated hemoglobin (HbA1c) and fasting blood glucose versus control.
Therefore, “[w]hen recommending weight loss for adults with obesity and prediabetes, clinicians should consider prescribing a high dose of behavioral treatment,” Perri and co-authors write in BMJ Open Diabetes Research & Care.
The study included 287 participants (77% women) of the Rural LITE Trial with a mean BMI of 36.3 kg/m2 and a mean HbA1c of 5.9%, who were randomly assigned to receive weekly behavioral treatment session at a high (24 sessions), moderate (16 sessions), or low (eight sessions) dose, or to a nutrition education control group.
The intervention was based on the US Diabetes Prevention Program and focused on eating a low-calorie diet, increasing physical activity levels, and employing behavior change strategies such as goal-setting and monitoring of caloric intake and step count to induce a negative energy balance. Participants in the control group were not given specific caloric intake or physical activity goals and did not receive advice on behavioral strategies for weight management.
After 6 months, people in the high- and moderate-dose groups experienced significant reductions in HbA1c and fasting blood glucose compared with baseline whereas those in the low-dose and control groups did not.
Specifically, mean reductions in HbA1c were 0.11%, 0.08%, 0.03%, and 0.02%, for the high, moderate, low, and control groups, respectively, while those for fasting blood glucose were 0.26 mmol/L, 0.09 mmol/L, 0.01 mmol/L, and 0.04 mmol/L, respectively.
When the researchers conducted inter-group comparisons, they found that “the high-dose treatment produced significantly greater reductions in HbA1c and fasting blood glucose than the low-dose and control conditions,” but “no other significant between-group differences were observed.”
By contrast, there were significant differences between all groups, with the exception of high versus moderate dose, in mean weight loss from baseline to 6 months, at 10.91 kg, 10.08 kg, 6.35 kg, and 3.82 kg in the high, moderate, low, and control groups, respectively.
Perri et al say: “The findings from the current study argue for standardization in how dose of behavioral treatment is defined and recommended.
“A common definition of optimal treatment dose will aid in the communication of appropriate prescriptions for behavioral treatment.”
They add: “Moreover, treatment recommendations should take into account whether the target outcome is weight loss alone or weight loss with improved glycemic control.”
By Laura Cowen
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