Weight Management, Group Visits Help Patients With Diabetes Achieve Glycemic Control

Patients with diabetes who participated in a program of group medical visits (GMVs) and intensive weight management showed improvements in glycemic control, according to a study published in JAMA Internal Medicine.

In GMVs, patients who share a chronic condition receive education, self-management skills training, and medication management. This study took place at 2 sites in North Carolina and included 2 arms. Both arms received a GMV intervention, but only 1 arm including weight management (WM/GMV arm), while the other focused on medication intensification (GMV arm).

Participants were veterans enrolled from Veterans Affairs Medical Center clinics in Durham and Greenville, North Carolina. They were enrolled between January 12, 2015, and May 30, 2017, and in order to be enrolled, they had to have type 2 diabetes, glycated hemoglobin A1C of at least 8% (or 7.5% if they were younger than 55 years), a body mass index of 27 or higher, and an interest in losing weight.

A total of 263 participants were randomized to the study arms. In the GMV arm, the groups met every 4 weeks for the first 16 weeks and then every 8 weeks thereafter. At the group sessions, they received diabetes counseling and medication management education from a nurse. Sessions lasted approximately 1.5 to 2 hours. In the WM/GMV arm, groups met every 2 weeks for 16 weeks for weight management counseling and medication management. After that time, they met every 8 weeks for diabetes counseling, medication management, and continue weight management support.

In the WM/GMV arm, participants met with a dietician, their carbohydrate intake was restricted initially, and they attended classes on topics such as grocery shopping, eating at restaurants, and recipe makeovers. Later visits included information on physical activity.

At every visit, the participants’ body weight was measured using a standard digital scale. Participants recorded medication changes, and medications were confirmed by a study physician. Participants also recorded hypoglycemic events and their blood pressure was measured twice at each visit. In addition, dietary intake was assessed at baseline and every 16 weeks.

From baseline to 48 weeks, A1C decreased 0.9% in the WM/GMV arm and 0.8% in the GMV arm. A larger proportion of patients in the WM/GMV arm compared with the GMV arm achieved an A1C below 7.5% (44.0% in WM/GMV vs 29.1% in GMV). Participants in the WM/GMV arm also had fewer hypoglycemic events (3.2 vs 6.6) during the 48 weeks of the study.

“Given these benefits and the knowledge that lifestyle changes can be difficult to maintain, we should continue to develop strategies that help patients sustain these improvements,” the authors concluded.

Reference

Yancy WS, Crowley MJ, Dar MS, et al. Comparison of group medical visits combined with intensive weight management vs group medical visits alone for glycemia in patients with type 2 diabetes: a noninferiority randomized clinical trial [published online November 4, 2019]. JAMA Intern Med. doi:10.1001/jamainternmed.2019.4802.