In the Journals

Individualized lifestyle intervention may reduce type 2 diabetes risk in HIV

For adults with HIV, a lifestyle intervention focused on energy restriction, weight reduction and improved diet may be an effective way to decrease type 2 diabetes risk, according to findings published in Diabetic Medicine.

“Traditional diabetes risk factors, such as obesity, whilst characteristically much less prevalent in the early years of the HIV epidemic, are becoming increasingly common as the HIV phenotype changes from one of wasting and premature death to one of obesity and increased life expectancy,” Louise Goff, PhD, of the department of diabetes and nutrition at King’s College London, and colleagues wrote.

Goff and colleagues recruited 28 adults (mean age, 54 years; 25% women) with HIV and impaired fasting glucose between 6 mmol/L and 6.9 mmol/L for a mixed-methods exploratory study between February 2014 and September 2015.

The participants took part in a 6-month intervention that included monthly one-on-one visits with a research dietitian and monthly phone calls to discuss progress. Each participant was tasked with 10 individual goals pertaining to energy restriction, weight and waist reduction, increasing steps per day and altering diet by limiting saturated fat, sodium and sugar intake while increasing consumption of whole grains, fruits and vegetables.

After 6 months, the participants took part in an assessment visit that measured changes in glucose and insulin incremental area under the curve (iAUC) compared with baseline using a 3-hour meal tolerance test. After the participants consumed a 200-g meal that included 60 g carbohydrates, 19 g protein and 18 g fat, researchers measured glucose, insulin, glucose-dependent insulinotropic polypeptide (GIP) and GLP-1 via blood samples taken at 5, 10, 15 and 30 minutes and then at every 30-minute interval up to 180 minutes. In addition to these measures, participants took part in interviews after the intervention with a dietitian to discuss the acceptability of the intervention and any barriers to involvement or goal attainment.

After the intervention, the researchers found reductions in fasting glucose (–7.9%; P = .003), glucose iAUC (–17.6%; P = .023), fasting insulin (–22.7%; P = .021), insulin iAUC (–31.4%; P = .017), GIP iAUC (–25.1%; P = .006), homoeostatic model of assessment of insulin resistance score (–26.7%; P = .011), weight (–4.6%; P < .001), waist circumference (–6.2%; P < .001), triglycerides (–36.7%; P = .002) and 10-year cardiovascular risk (–13.5%; P = .001).

In terms of goal achievement, 22% of participants met more than the median of five goals, with decreased sodium intake the most prevalently achieved (82%). In addition, although most interviewees indicated that the intervention was “acceptable,” the intervention led some participants to express concern about their HIV status being exposed along with other barriers.

“The findings from our qualitative work suggest that the successful change experienced by the majority of our participants was related to motivation associated with a sense of control regarding diabetes prevention; however, additional layers of complexity exist in people living with HIV, which need to be addressed when supporting them to make lifestyle changes,” the researchers wrote. “Nevertheless, there are significant enablers of and barriers to adopting behavior change, a number of which are HIV-specific, which should be taken into account when designing interventions for research and clinical practice.” – by Phil Neuffer

Disclosures: The authors report no relevant financial disclosures.

For adults with HIV, a lifestyle intervention focused on energy restriction, weight reduction and improved diet may be an effective way to decrease type 2 diabetes risk, according to findings published in Diabetic Medicine.

“Traditional diabetes risk factors, such as obesity, whilst characteristically much less prevalent in the early years of the HIV epidemic, are becoming increasingly common as the HIV phenotype changes from one of wasting and premature death to one of obesity and increased life expectancy,” Louise Goff, PhD, of the department of diabetes and nutrition at King’s College London, and colleagues wrote.

Goff and colleagues recruited 28 adults (mean age, 54 years; 25% women) with HIV and impaired fasting glucose between 6 mmol/L and 6.9 mmol/L for a mixed-methods exploratory study between February 2014 and September 2015.

The participants took part in a 6-month intervention that included monthly one-on-one visits with a research dietitian and monthly phone calls to discuss progress. Each participant was tasked with 10 individual goals pertaining to energy restriction, weight and waist reduction, increasing steps per day and altering diet by limiting saturated fat, sodium and sugar intake while increasing consumption of whole grains, fruits and vegetables.

After 6 months, the participants took part in an assessment visit that measured changes in glucose and insulin incremental area under the curve (iAUC) compared with baseline using a 3-hour meal tolerance test. After the participants consumed a 200-g meal that included 60 g carbohydrates, 19 g protein and 18 g fat, researchers measured glucose, insulin, glucose-dependent insulinotropic polypeptide (GIP) and GLP-1 via blood samples taken at 5, 10, 15 and 30 minutes and then at every 30-minute interval up to 180 minutes. In addition to these measures, participants took part in interviews after the intervention with a dietitian to discuss the acceptability of the intervention and any barriers to involvement or goal attainment.

After the intervention, the researchers found reductions in fasting glucose (–7.9%; P = .003), glucose iAUC (–17.6%; P = .023), fasting insulin (–22.7%; P = .021), insulin iAUC (–31.4%; P = .017), GIP iAUC (–25.1%; P = .006), homoeostatic model of assessment of insulin resistance score (–26.7%; P = .011), weight (–4.6%; P < .001), waist circumference (–6.2%; P < .001), triglycerides (–36.7%; P = .002) and 10-year cardiovascular risk (–13.5%; P = .001).

In terms of goal achievement, 22% of participants met more than the median of five goals, with decreased sodium intake the most prevalently achieved (82%). In addition, although most interviewees indicated that the intervention was “acceptable,” the intervention led some participants to express concern about their HIV status being exposed along with other barriers.

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“The findings from our qualitative work suggest that the successful change experienced by the majority of our participants was related to motivation associated with a sense of control regarding diabetes prevention; however, additional layers of complexity exist in people living with HIV, which need to be addressed when supporting them to make lifestyle changes,” the researchers wrote. “Nevertheless, there are significant enablers of and barriers to adopting behavior change, a number of which are HIV-specific, which should be taken into account when designing interventions for research and clinical practice.” – by Phil Neuffer

Disclosures: The authors report no relevant financial disclosures.