Prevent Type 2 Diabetes with Internet and Coaches: New Study

Prevent type 2 diabetes with internet and coaches
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An estimated 79 million people in the United States alone are at risk for diabetes, and the number is likely even higher. Physicians have a challenge trying to prevent type 2 diabetes in their high-risk patients, but now the results of a new study that combined use of the internet and coaches may provide a new, effective approach.

How do we prevent type 2 diabetes?

Experts are certain about the main risk factors for type 2 diabetes, which include lifestyle factors such as being overweight or obese, lack of exercise, and poor diet. However, encouraging individuals to make the lifestyle changes necessary to lose weight, exercise, and eat a healthful diet requires lots of effort from healthcare providers and cooperation from patients.

While a previous study (Diabetes Prevention Program) found that intensive, one-on-one intervention headed by lifestyle coaches resulted in a 58 percent reduction in the incidence of type 2 diabetes, such an approach is not always practical, especially given the tremendous number of people who need help and the burden on the healthcare system.

Now investigators at Stanford University School of Medicine and the Palo Alto Medical Foundation Research Institute have reported that individuals exposed to Internet support along with a take-home DVD could improve the ability of coaching techniques and reach more people in need of assistance in preventing type 2 diabetes.

According to the new study's senior investigator, Randall Stafford, MD, PhD, professor of medicine at the Stanford Prevention Research Center, the challenge for researchers was to utilize what worked in the previous study, which was the coaching aspect, and "get it to the point where it could be established as a program in large group practices."

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As part of that attempt, the researchers randomly assigned a group of prediabetes patients into three groups: one led by a coach (79 participants), one in which participants used a self-directed DVD (81), and one involving usual care (81). Individuals in the first two groups were offered practical tips on nutrition, exercise, and mental/behavior methods to help them stay with their new diet and exercise habits. These strategies were followed for three months.

At the end of the three months, the one-year follow-up phase began. During that time, all the participants received regular e-mails that encouraged them to continue following all they had learned during the three-month intervention, and they were asked to monitor their goals via the American Heart Association's Heart360 website.

Here is a summary of the findings at the end of the 15-month study:

  • Mean change in body mass index (BMI) was 2.2 in the coach-led group, 1.6 in the DVD group, and 0.9 in the usual care group. The average BMI was 32.0 at the beginning of the study (30.0 is the breaking point for obesity).
  • The mean amount of weight individuals lost over the 15-month trial was 13.9 pounds in the coach-led group, 9.9 pounds in the DVD group, and 5.3 pounds in the usual care group
  • Waist circumference declined in both intervention groups compared with the usual care group
  • Women tended to get better results from the coach-led group while men responded equally well to both types of intervention. Although the group was too small for this information to reach significance, the finding does suggest different interventions work better for some people than for others.

In a study conducted by researchers at Yale University School of Medicine and published last month in the Journal of Clinical Endocrinology and Metabolism, the authors warned of a diabetes tsunami, saying that it was "imminent, and the only way to minimize the damage is to create an early warning system and improve interventions to protect those in its path."

The results of this newest study provide an intervention option that may help prevent development of type 2 diabetes in individuals at risk. A combination of Internet resources, coaches, and other novel methods may be necessary to fight this serious disease and its often devastating complications.

SOURCES:
Ma J et al. Translating the Diabetes Prevention Program lifestyle intervention for weight loss into primary care: a randomized trial. Archives of Internal Medicine 2012; 172(19): 1-9
Sherwin R, Jastreboff AM. Year in diabetes 2012: the diabetes tsunami. Journal of Clinical Endocrinology and Metabolism 2012 Nov 26

Image: Morguefile

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