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Diabetes: Can Health Care Systems Motivate Patients to Change their Lifestyles and Improve their Health? #2013ada

Previous research has shown that lifestyle changes such as increasing exercise and making better food choices can help people lose weight, and prevent diabetes and its complications. But until now, those studies have focused on highly motivated individuals who volunteered to be part of the research. Could the same hold true for patients told by their health care providers to make changes? According to research presented today at the American Diabetes Association's 73rd Scientific Sessions®, it could.

The landmark NIH Diabetes Prevention Program (DPP) has previously shown that intensive, one-on-one lifestyle intervention could help people lose weight and dramatically reduce their risk for developing type 2 diabetes. Out of this research, a template for similar interventions to be used in less expensive group settings was developed. Several smaller, community-based studies have proven successful using this model, but these have all been conducted with participants who volunteered for the research, suggesting a high level of motivation. This study, using participants from VA Medical Centers across the country, looks at what happens when patients are told by their health care providers that they need to make changes.

"We wanted to see how effective a lifestyle change program would be for patients in a national health care system," said Sandra L. Jackson, MPH, a PhD candidate in Nutrition and Health Sciences at Emory University in Atlanta, whose dissertation research focuses on this question. "In order to achieve wide-scale results in reducing the prevalence of diabetes in this country, we need to get to patients who are at risk. One way of doing this is through their health care providers, and such a strategy – if found to be effective – could be replicated across many healthcare systems."

Jackson analyzed the records of 400,000 patients in a VA program known as MOVE! (Managing Obesity and Overweight in Veterans Everywhere). Patients were directed to the program by their health care providers during routine medical visits.

The MOVE! program, offered at 130 VA hospitals and clinics across the country, consists of weekly group lifestyle intervention sessions focused on issues such as nutrition and physical activity. The program differs slightly from facility to facility and may be run by diabetes educators, nutritionists, exercise physiologists and others with expertise in its various components.

Among all participants, the researchers found weight loss of 1.3 percent of body weight, on average, was maintained over a three-year period. Among those who enrolled in eight or more sessions over six months (a more active group of participants), they found substantially greater weight loss of 2.7 percent of body weight (5.4 pounds in a person weighing 200 pounds).

They also found that those veterans who had already been diagnosed with diabetes were more likely to become active participants in the program than those who did not have diabetes at the start of the program. Additionally, those who lost more weight at six months were less likely to develop diabetes over three years: preliminary results revealed that for every additional pound of weight lost, the risk for developing type 2 diabetes dropped by about one percent, adjusted for baseline BMI, age and gender.

"Around the country, there are hundreds of millions of Americans who are involved in one health care setting or another," said Lawrence S. Phillips, MD, Professor of Medicine at Emory University School of Medicine, Division of Endocrinology, and Director of the Clinical Studies Center at the Atlanta VA Medical Center. "Diabetes is a problem of epidemic proportions. We are older, heavier and more sedentary as a society, and these are cardinal factors in the diabetes epidemic. The key way to reverse this is lifestyle change. The good news is, this research shows that participation does not have to be entirely voluntary to work, and the health care system can and should be part of the solution."