A telephone-delivered behavioural intervention confers a small reduction in body weight in people with Type 2 diabetes

Blikk på forskning i Fysioterapeuten 6/2014.

Fagartikkel

Blikk på forskning utarbeides i samarbeid med Journal of Physiotherapy (Australia), som trykker forskningspresentasjonene under betegnelsen Critically appraised Papers, CAPs.

Synopsis

Summary of: Eakin EG, et al (2013) Six-month outcomes from living well with diabetes: a randomized trial of a telephone-delivered weight loss and physical activity intervention to improve glycemic control. Ann Behav Med [Epub ahead of print doi.10.1007/s12160-013-9498-2.] [Prepared by Kylie Hill, CAP Editor.]

Question: Does a telephone-delivered intervention aimed at increasing physical activity and improving dietary intake serve to reduce weight, increase physical activity and improve glycaemic control in people with Type 2 diabetes?

Design: Randomised controlled trial with blinded outcome assessors.

Setting: The participants’ homes in the city of Logan, Australia.

Participants: People were eligible to participate if they were aged 20–75 years, had Type 2 diabetes, were inactive, had a body mass index ≥ 25 kg/m2, were not using weight loss medication, and had no previous or planned bariatric surgery. Randomisation, using the minimisation method, allocated 151 participants each to the intervention and control groups.

Interventions: Over a six-month period, the intervention involved 14 phone calls which comprised motivational interviewing, focusing on the benefits of weight loss and lifestyle changes together with goal setting to achieve specific targets related to weight loss, physical activity, and dietary intake. Participants were also provided with a workbook, a pedometer (to monitor daily step counts), and a set of digital scales (to monitor body weight). They were encouraged to achieve weight loss through exercise (≥ 210 minute/week) and a reduction in energy and total fat intake. The control group received generic self-management brochures about Type 2 diabetes.

Outcome measures: The primary outcomes were weight loss, accelerometer-derived moderate to vigorous physical activity, and glycosylated haemoglobin (HbA1c).

Results: A total of 279 participants completed the study. On completion of the intervention period, compared with those in control group, those in the intervention group achieved greater weight loss (–1.1%, 95% CI –1.9 to –0.3). This betweengroup difference was equal to –1.1 kg. The intervention group also performed more physical activity (30%, 95% CI 8 to 57). This between-group difference was equal to 31 minutes of moderate to vigorous physical activity per week. There were no differences in HbA1c.

Conclusion: Telephone-delivered motivational interviewing was a pragmatic option for encouraging a healthier lifestyle and conferred benefits in weight loss and physical activity for adults with Type 2 diabetes.

Commentary

The prevalence of Type 2 diabetes and other metabolic disorders is rapidly increasing, perpetuating a clear and present public health risk (Wild et al 2004). There is substantial evidence that intensive clinic-based lifestyle interventions targeting increased physical activity and reduced energy intake are effective in producing significant weight loss and improving Type 2 diabetes biomarkers (Norris et al 2004). However, evidence is lacking regarding the feasibility of translating these interventions into the wider community. The ‘Living Well with Diabetes’ trial described in this paper delivered a weight loss intervention entirely over the telephone in an attempt to increase program reach beyond the metropolitan clinic setting. It used an evidence-based combined approach of increasing energy expenditure through physical activity, and reducing energy intake through healthy eating principles; importantly it incorporated behavioural change strategies to target and individualise the program according to participant need and circumstances, to increase program uptake and adherence. Although the program conferred benefits in weight loss, energy intake reduction, dietary quality and physical activity, the effects sizes were relatively small with few Type 2 diabetes participants meeting program targets.

Additionally, no change in blood glucose was detected, possibly due to lack of program focus on medication adherence. Effects were greatest in program completers who received the majority of calls, favouring those who were retired. Study outcomes point to the dilemma for clinicians of targeting programs to those most able or motivated to change compared with a ‘take all comers’ approach, to optimise inclusion of those from socially disadvantaged and minority groups. It is likely that more flexible modular approaches in goal setting and delivery, including internet and pervasive smart phone technology, will be necessary to achieve greater program impact and reach, as demonstrated in successful secondary prevention of cardiovascular disease (Neubeck et al 2011).

Martin Mackey, The University of Sydney, Australia

References

Wild S et al (2004) Diabetes Care 27: 1047–1053.

Norris S et al (2004) Am J Med 117: 762–774.

Neubeck L et al (2011) Eur J Cardiovasc Nurs 10: 213–220.