Intensive Lifestyle Therapy Improves Glycemic Control, Lessens Diabetic Medication

Mihoko Yoshino, MD, PhD

Intensive lifestyle therapy provided in a workplace setting was associated with significant increases in muscle development and decreases in fasting blood glucose and HbA1c levels in patients with type 2 diabetes and obesity.

The findings, presented at the American Diabetes Association (ADA) 2021 Scientific Sessions this week, additionally showed that these outcomes were possible at the same time as reducing diabetes medication by approximately 60% in patients undergoing therapy.

Led by Mihoko Yoshino, MD, PhD, assistant professor of Medicine at the John T. Milliken Department of Medicine, Washington University School of Medicine in St. Louis, investigators conducted an 8-month randomized, controlled study observed intensive lifestyle therapy in patients with type 2 diabetes and obesity.

“Weight loss and exercise are the cornerstones of therapy for patients with obesity and type 2 diabetes,” they wrote. “However, successful compliance with therapy is difficult to achieve.”

Their assessment, conducted at a workplace setting, observed the benefit of intensive lifestyle therapy on patient bodyweight, cardiometabolic function, and cellular metabolic pathways.

Patients were assigned to either standard care (n = 8) or ITL (n = 10). Mean baseline patient BMI was 38±5 and 37±6, respectively. Fasting blood glucose levels were 161±19 mg/dl and 150±32 mg/dl, respectively. HbA1c levels were 7.6±1.1% and 7.0±1.1%, respectively.

Intensive lifestyle therapy included weekly diet-behavior therapy sessions for patients, as well as 4 weekly supervised resistance and endurance exercise training courses.

Yoshino and colleagues observed improvements in all cardiometabolic outcomes among patients treated with intensive lifestyle therapy versus standard care—insulin sensitivity,

β-cell function, and cardiorespiratory fitness (per VO2 peak during cycle ergometer exercise) each significant improved with the comprehensive therapy.

What’s more, intensive lifestyle therapy increased muscle NAD content by approximately 51% versus standard care (P <.05). Investigators observed fasting blood glucose and HbA1c decreases of 108±31 mg/dl and 6.1±0.9%, respectively, among intensive lifestyle therapy patients. At the same time, diabetes medication use in this population decreased by 60%, versus no change in standard care patients.

Finally, weight loss per BMI was significantly greater in the intensive lifestyle therapy group at 8 weeks: 17±7% reduction versus 1±2% (P <.05).

“We conclude that marked diet-induced weight loss and exercise training can be achieved in a structured worksite setting and has profound therapeutic cardiometabolic effects in people with obesity and type 2 diabetes,” investigators wrote.

The study, “Effect of Intense Lifestyle Therapy in People with Obesity and Type 2 Diabetes,” was presented at ADA 2021.