In the Journals Plus

Fully automated diabetes intervention improves physical activity, eating habits

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September 26, 2016

Adults with prediabetes assigned to a fully automated diabetes prevention program for 6 months showed improvements in physical activity and dietary variables vs. a control group assigned to a wait list, according to findings from a randomized controlled trial.

“This study showed that this email- and web-based intervention helped people to make the eating and physical activity behavior changes that can help prevent progression to diabetes,” Gladys Block, PhD, scientific director of Turnaround Health in Berkeley, California, told Endocrine Today. “These behavioral changes paralleled the significant impact of the program in lowering HbA1c, fasting glucose, weight, metabolic syndrome and other factors that were reported in an earlier paper.”

Gladys Block
Gladys Block

Block and colleagues analyzed data from 339 adults with prediabetes (mean age, 55 years; 69% men; 68.1% with metabolic syndrome) who were randomly assigned to immediately begin the Alive-PD program, a 1-year intervention designed to prevent the development of type 2 diabetes (n = 163) or to begin the program after 6 months (controls; n = 176). Within the cohort, 95% had prediabetes confirmed by fasting glucose measurement; 45% had prediabetes confirmed by HbA1c.

At baseline, participants reported engaging in leisure-time aerobic activity for a mean of 2.29 days per week and reported eating fruits and vegetables 1.28 times per day (about nine times per week). At 6 months, both groups changed behaviors in physical activity and dietary choices, reporting decreases in the intake of bread, pasta/white rice and sweets, as well as red meat.

However, effect sizes for changes in fruit and combined fruit and vegetable were 0.58 and 0.62, respectively. Effect sizes for aerobic activity, refined carbohydrates, sweets and vegetables ranged from 0.34 to 0.49.

With the exception of red meat, researchers observed differences between the intervention group and controls in intention-to-treat analysis, researchers wrote.

“Changes in eating and activity behaviors are what we hope for, both in diabetes prevention and diabetes management,” Block said. “Such changes are not always achieved, yet are key for long-term effectiveness. This program adds a tool that can help.

“The small number of individuals in the trial who were in the diabetic range by fasting glucose all reduced their fasting glucose to either the pre-diabetic or the normal range,” Block said.

“We would like to be able to test the program in a population with type 2 diabetes, to support the efforts of diabetes educators and endocrinologists to help patients improve their eating and activity behaviors,” she said. – by Regina Schaffer

Disclosure: Block and two other researchers are co-owners of Turnaround Health, which developed Alive-PD.

itj+ Perspective

PERSPECTIVE
Meghan Jardine

Meghan Jardine

This randomized controlled trial demonstrates that a web-based lifestyle intervention can be effective in improving specific behaviors that reduce the onset of type 2 diabetes. Here, the investigators measured the abundance of fruit and vegetable consumption, reductions in refined carbohydrates, improvements in physical activity, and self-rated health. Goals were individually tailored based on an online questionnaire and health-related goals. The intervention group saw significant improvements in healthy eating and exercise behaviors as well as gains in overall quality of life, general wellness, and productivity, in comparison to the control group. A previous analysis of this cohort confirms these behavioral changes result in improvements in glycemic control, body weight, BMI, waist circumference, TG/HDL ratio, and diabetes risk.
The Diabetes Prevention Program (DPP) demonstrates that intensive lifestyle therapy, specifically a low-fat, reduced calorie diet and physical activity, reduces the risk of type 2 diabetes by 58 percent. These behavior changes are even more effective for people over the age of 60, reducing the risk by 71 percent. Interestingly, these lifestyle changes outperform metformin therapy, which decreases the diabetes risk by 31 percent. Healthy eating and physical activity improves insulin sensitivity and, other health parameters, including blood pressure, lipids, and body weight, which single-handedly and collectively reduce the risk of cardiovascular disease, the number one cause of death for people who struggle with type 2 diabetes.
It’s important that clinicians screen for diabetes risk factors to identify those who would benefit most from lifestyle intervention. Risk factors include being physically inactive, family history and background (ethnicity/race), giving birth to a baby weighing more than 9 pounds, high blood pressure, low HDL-cholesterol and/or high triglycerides, polycystic ovary syndrome, impaired fasting glucose or glucose intolerance, acanthosis, and a history of cardiovascular disease.
Intensive lifestyle therapy can be expensive, but so are the costs of diabetes. This automated, web-based intervention may offer an inexpensive and accessible alternative. A long-term follow up of this cohort would reveal whether an automated program like this is as effective as the DPP in the prevention of type 2 diabetes.


Meghan Jardine, MS, MBA, RD, LD, CDE
Associate Director of Diabetes Nutrition Education, Physicians Committee for Responsible Medicine

Disclosure: Jardine reports no relevant financial disclosures.