Study Results Promote Addition of Weight Loss Counseling for Diabetics

A new study from investigators at the Duke University Diet and Fitness Center has found weight loss and group counseling for diabetics can be just as effective as conventional medication management for lowering HbA1c.

Results of the 2-arm randomized clinical trial of more than 200 patients indicated group medical visits combined with weight management was non inferior to conventional medication management of HbA1c and showed advantages in other clinically important outcomes.

“Group medical visits are an increasingly popular way to care for diabetes patients,” said lead investigator William Yancy, MD, director of the Duke Diet & Fitness Center and research associate at the Durham VA Medical Center. “This approach can be efficient for patients who share a common chronic condition, enabling them to receive education, self-management skills training, and medication management to improve clinical outcomes.”

Investigators designed their 2-arm trial to examine whether group medical visits combined with intensive weight management was non inferior to group medical visits alone for HbA1c and superior to group medical visits alone for hypoglycemic events, diabetes medication intensity, and weight loss. Patients included in the trial were identified through electronic medical records from the Veterans Affairs Medical Center clinics in Durham and Greenville, NC between January 12, 2015 and May 30, 2017.

Inclusion requirements for the current analysis included having type 2 diabetes, HbA1c level if at least 8%, BMI of 27 or higher, and interest in losing weight. Participants were excluded if they were 75 or older, had hemoglobinopathy, certain chronic or unstable disease, were pregnant, had dementia, unstable psychiatric illness, or substance abuse, and if enrolled in another study that could impact outcomes.

Of the 2814 eligible for the study, 438 consented to participate. Of this groups, 263 were deemed eligible and attended the first group session. Participants in the study had a mean age of 60.7 years, HbA1c level of 9.1% and a BMI of 35.3.

Participants were randomized to receive either weight management and group medical visits or only group medical visits. A total of 136 were included in the group medical visits-only group compared to 127 in the combination group.

Patients randomized to the group medical visits group received consoling every 4 weeks for 16 weeks, then every 8 weeks. Conversely, patients in the combination group received diet counseling with baseline medication reduction and subsequent optimization every 2 weeks for 16 weeks followed by an abbreviated group medical visit intervention every 8 weeks.

At 48 weeks, investigator noted HbA1c levels had improved in both arms of the study, with levels at 8.2% in the combination group and 8.3% in the group medical visits arms (mean difference, −0.1%; 95% CI, −0.5% to 0.2%; upper 95% CI, <0.5% threshold; P=0.44). Additionally, the combination arm had lower diabetes medication use (mean difference in medication effect score, −0.5; 95% CI, −0.6 to −0.3; P<0.001) and greater weight loss (mean difference, −3.7 kg; 95% CI, −5.5 to −1.9 kg; P<0.001) than the group medical visits arm and nearly 50% less hypoglycemic events (incidence rate ratio, 0.49; 95% CI, 0.27 to 0.71; P<0.001) during the 48-week study period.

“Intensive weight management using a low-carbohydrate diet can be as effective for glycemic improvement as medication intensification,” Yancy said. “We know that lifestyle changes can be difficult to maintain, but this study shows that group meetings can be an efficient and effective strategy that helps patients sustain these improvements.”

This study, titled “Comparison of Group Medical Visits Combined With Intensive Weight Management vs Group Medical Visits Alone for Glycemia in Patients With Type 2 Diabetes,” was published online in JAMA Internal Medicine.