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.
    Full-text · Article · Apr 2014 · PLoS ONE
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    • "Several studies have shown the potential value of telecommunication technology in improving physical activity levels in chronic patients [13] [14] [15]. Telecommunication technologies are often used for providing feedback on subjectively experienced physical activity behaviour [16]. "
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    ABSTRACT: To study the compliance with a physical activity monitoring and feedback intervention, as implemented for balancing daily physical activity in patients with the chronic fatigue syndrome. The intervention was implemented into an existing rehabilitation program for treatment of chronic fatigue syndrome. Feedback was provided at home with a personal digital assistant during four consecutive feedback periods. Compliance with the feedback system was around 90% during each of the four feedback periods. Fifteen patients (50%) complied with all four feedback periods. The fifteen compliers changed their physical activity level significantly into the direction of the goal, especially in the morning and afternoon. Changes in physical activity were seen instantaneously from the first feedback day on. Patients were able to change their daily physical activity into the direction of the goal. The compliance with all four feedback periods was low and might be related to the instantaneous effect of the feedback.
    Full-text · Conference Paper · Sep 2013
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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.
    Full-text · Article · May 2013 · BMC Public Health
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