Intensive diabetes program has lasting effects

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People with type 2 diabetes who took part in a multi-pronged weight management program lost weight and were able to keep it off long-term, new research shows.

What’s more, individuals who participated in the 12-week Why WAIT (Weight Achievement and Intensive Treatment) program cut their cholesterol levels, kept their blood glucose under better control, and sharply reduced their use of diabetes medications and insulin, lead author Dr. Osama Hamdy of the Joslin Diabetes Center in Boston and colleagues found.

“In treating type 2 diabetes, we have been glucose-focused for several decades. It may be the time to switch our efforts to target body weight as the core of the problem,” Hamdy noted in a press release from Joslin. More than 85 percent of U.S. adults with diabetes are overweight or obese, he and his colleagues point out in the journal Diabetes Care.

Hamdy and his team report on a 12-month follow-up of 62 men and women who participated in the Why WAIT program. Elements include intensive, tailored management of diabetes medication; individualized meal plans; exercise plans and coaching; weekly cognitive behavioral group therapy; and weekly group education sessions.

After the program, weight loss had averaged 23.5 pounds, or 9.8 percent of initial body weight, and study participants trimmed 3.7 inches from their waistlines. After a year, patients were still 18.2 pounds lighter, on average, representing a 7.6 percent reduction in their original body weight.

Among the study participants taking short-acting insulin, 21 percent were able to quit, while the rest of those on insulin therapy cut their dosage by more than half. Nearly two-thirds of study participants taking diabetes drugs called sulfonylureas, which are associated with weight gain, stopped taking them, while the rest reduced their dosage significantly.

Reductions in medication use would save about $560 a year, the researchers say, while the average 12.2 percent reduction in total cholesterol, 21.8 percent drop in triglycerides,11.4 percent reduction in LDL cholesterol, and 1 percent reduction in hemoglobin A1c seen in the study would translate to about $1,800 less in annual direct medical costs per patient.

The Why WAIT program is “mostly covered by medical insurance,” Hamdy and his team point out in their report. But for it to become a standard part of routine clinical practice, they say, “wider endorsement by third-party payers” may be necessary.

SOURCE: Obesity Management, August 2008.

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