Type 2 Diabetics Can Lose Pounds, Take Less Medication with Dietician Support

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A one-year study involving 118 obese people with type 2 diabetes by the University of Virginia Health System found that lifestyle management by registered dietitians resulted in less use of prescription medications, weight loss, reduced waist size and an improved quality of life compared to the usual diabetes care.

The study, published in the July issue of the journal Diabetes Care, concluded that a case management approach led by registered dietitians can improve the health of obese people with type 2 diabetes at a modest cost.

Researchers at U.Va. randomized obese patients with type 2 into a lifestyle case management group and a usual care group. All patients volunteered for the study.

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The lifestyle case management group received individual and group counseling and education on diet and physical activity, plus support and referrals by one registered dietitian case manager. The usual care group received educational material only. Both groups received usual medical care.

The results showed that, over one year, the case management group lost an average of 5.3 pounds and 2.2 inches in their waist size. Most weight loss happened when the patients had more frequent contact with the dietitian case managers. This group also took fewer diabetes medications per day than usual care patients, especially insulin and sulfonyluria, and reported a greater sense of well-being.

The usual care group, however, gained an average of 1.3 pounds, while waist size was little changed. (Some in that group lost up to one-half inch in their waist size.)

"Both public health and clinical interventions are needed to stem the epidemic of obesity and diabetes," said Anne Wolf, an instructor in the Department of Health Evaluation Sciences at U.Va., who along with other researchers at the Department co-authored the study with scientists at U.Va.'s Division of Endocrinology and Metabolism. "If we continue to treat diabetics without a sustainable lifestyle component, they're likely to experience what some in the usual care group experienced: weight gain, increased waist circumference and lower quality of life, despite higher levels of medications."

The case management approach exists in the health care system today, Wolf stressed, and

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