Clinic-Based Support to Help Overweight Patients With Type 2 Diabetes Increase Physical Activity and Lose Weight

PHCC LP, Pueblo, Colorado 81003, USA.
Archives of Internal Medicine (Impact Factor: 17.33). 02/2008; 168(2):141-6. DOI: 10.1001/archinternmed.2007.13
Source: PubMed


Our objective was to test the effect of physicians providing brief health lifestyle counseling to patients with type 2 diabetes mellitus during usual care visits.
We conducted a randomized controlled trial of a 12-month intervention at 2 large community health centers, enrolling 310 patients with a body mass index (calculated as weight in kilograms divided by height in meters squared) of 25 or greater. In the intervention group, self-management goals for nutrition and physical activity were set using a tailored computer program. Goals were then reviewed at each clinic visit by physicians. The control group received only printed health education materials. The main outcome measures included change in physical activity and body weight.
In the intervention group, recommended levels of physical activity increased from 26% at baseline to 53% at 12 months (P< .001) compared with controls (30% to 37%; P= .27), and 32% of patients in the intervention group lost 6 or more pounds at 12 months compared with 18.9% of controls (odds ratio, 2.2; P= .006).
A brief intervention to increase the dialogue between patients and health care providers about behavioral goals can lead to increased physical activity and weight loss.

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    • "Six trials [31], [32], [35], [36], [37], [38] used interventions designed to improve communication skills. Three trials [28], [30], [39] used some form of motivational interviewing based on the stages of change model [40]. One trial used shared decision making [41], one used patient-centered care [33], one used empathic care [29], and one used cultural competency training [34]. "
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    ABSTRACT: To determine whether the patient-clinician relationship has a beneficial effect on either objective or validated subjective healthcare outcomes. Systematic review and meta-analysis. Electronic databases EMBASE and MEDLINE and the reference sections of previous reviews. Included studies were randomized controlled trials (RCTs) in adult patients in which the patient-clinician relationship was systematically manipulated and healthcare outcomes were either objective (e.g., blood pressure) or validated subjective measures (e.g., pain scores). Studies were excluded if the encounter was a routine physical, or a mental health or substance abuse visit; if the outcome was an intermediate outcome such as patient satisfaction or adherence to treatment; if the patient-clinician relationship was manipulated solely by intervening with patients; or if the duration of the clinical encounter was unequal across conditions. Thirteen RCTs met eligibility criteria. Observed effect sizes for the individual studies ranged from d = -.23 to .66. Using a random-effects model, the estimate of the overall effect size was small (d = .11), but statistically significant (p = .02). This systematic review and meta-analysis of RCTs suggests that the patient-clinician relationship has a small, but statistically significant effect on healthcare outcomes. Given that relatively few RCTs met our eligibility criteria, and that the majority of these trials were not specifically designed to test the effect of the patient-clinician relationship on healthcare outcomes, we conclude with a call for more research on this important topic.
    PLoS ONE 04/2014; 9(4):e94207. DOI:10.1371/journal.pone.0094207 · 3.23 Impact Factor
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    • "Individuals with type 2 diabetes who receive self-management support from physicians, nurses, pharmacists, dieticians or other health professionals on the management of their diet [18], exercise and weight management [19] or combinations thereof [20] are generally more likely to make such changes. In a randomized control trial of patients with type 2 diabetes [19], a brief intervention to increase dialogue between patients and health care providers about lifestyle behavior modification for diabetes self-management significantly improved the level of recommended physical activity and weight loss. Our findings highlight the importance of health care provider communication, either through the provision of information or participatory decision-making, in patients’ behaviors for diabetes self-management. "
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    ABSTRACT: Background Lifestyle behavior modification is an essential component of self-management of type 2 diabetes. We evaluated the prevalence of engagement in lifestyle behaviors for management of the disease, as well as the impact of healthcare professional support on these behaviors. Methods Self-reported data were available from 2682 adult respondents, age 20 years or older, to the 2011 Survey on Living with Chronic Diseases in Canada’s diabetes component. Associations with never engaging in and not sustaining self-management behaviors (of dietary change, weight control, exercise, and smoking cessation) were evaluated using binomial regression models. Results The prevalence of reported dietary change, weight control/loss, increased exercise and smoking cessation (among those who smoked since being diagnosed) were 89.7%, 72.1%, 69.5%, and 30.6%, respectively. Those who reported not receiving health professional advice in the previous 12 months were more likely to report never engaging in dietary change (RR = 2.7, 95% CI 1.8 – 4.2), exercise (RR = 1.7, 95% CI 1.3 – 2.1), or weight control/loss (RR = 2.2, 95% CI 1.3 – 3.6), but not smoking cessation (RR = 1.0; 95% CI: 0.7 – 1.5). Also, living with diabetes for more than six years was associated with not sustaining dietary change, weight loss and smoking cessation. Conclusion Health professional advice for lifestyle behaviors for type 2 diabetes self-management may support individual actions. Patients living with the disease for more than 6 years may require additional support in sustaining recommended behaviors.
    BMC Public Health 05/2013; 13(1):451. DOI:10.1186/1471-2458-13-451 · 2.26 Impact Factor
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    • "For example, the CDMS includes point-of-care, guideline-based, patient-specific decision support for practitioners and tailored self-management support messages intended for patients. A number of systems that engage diabetic patients and their practitioners have demonstrated benefit in randomized trials [8-10,12]. The CDMS is also being enhanced to provide periodic clinician-level performance feedback, which was previously found to improve the quality of care when combined with patient-specific decision support [28]. "
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    ABSTRACT: Physicians practicing in ambulatory care are adopting electronic health record (EHR) systems. Governments promote this adoption with financial incentives, some hinged on improvements in care. These systems can improve care but most demonstrations of successful systems come from a few highly computerized academic environments. Those findings may not be generalizable to typical ambulatory settings, where evidence of success is largely anecdotal, with little or no use of rigorous methods. The purpose of our pilot study was to evaluate the impact of a diabetes specific chronic disease management system (CDMS) on recording of information pertinent to guideline-concordant diabetes care and to plan for larger, more conclusive studies. Using a before-after study design we analyzed the medical record of approximately 10 patients from each of 3 diabetes specialists (total = 31) who were seen both before and after the implementation of a CDMS. We used a checklist of key clinical data to compare the completeness of information recorded in the CDMS record to both the clinical note sent to the primary care physician based on that same encounter and the clinical note sent to the primary care physician based on the visit that occurred prior to the implementation of the CDMS, accounting for provider effects with Generalized Estimating Equations. The CDMS record outperformed by a substantial margin dictated notes created for the same encounter. Only 10.1% (95% CI, 7.7% to 12.3%) of the clinically important data were missing from the CDMS chart compared to 25.8% (95% CI, 20.5% to 31.1%) from the clinical note prepared at the time (p < 0.001) and 26.3% (95% CI, 19.5% to 33.0%) from the clinical note prepared before the CDMS was implemented (p < 0.001). There was no significant difference between dictated notes created for the CDMS-assisted encounter and those created for usual care encounters (absolute mean difference, 0.8%; 95% CI, -8.5% to 6.8%). The CDMS chart captured information important for the management of diabetes more often than dictated notes created with or without its use but we were unable to detect a difference in completeness between notes dictated in CDMS-associated and usual-care encounters. Our sample of patients and providers was small, and completeness of records may not reflect quality of care.
    BMC Medical Informatics and Decision Making 07/2012; 12(1):63. DOI:10.1186/1472-6947-12-63 · 1.83 Impact Factor
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