Xiao L, Yank V, Wilson SR, Lavori PW, Ma J., Nutr Diabetes. 3:e76. doi: 10.1038/nutd.2013.17., 2013 Jun 24
Investigators
Sandra Wilson, Ph.D., Senior Scientist
Abstract
Objective: To investigate whether the effects on weight loss and cardiometabolic
risk factor reduction of two technology-mediated lifestyle interventions for 15 months
in a primary care-based translation trial sustained at 24 months (that is, 9 months
after the end of intervention).
Design: This study analyzed data from an
extended follow-up of participants in the original 'E-LITE' (Evaluation of Lifestyle
Interventions to Treat Elevated Cardiometabolic Risk in Primary Care)-randomized controlled
trial, which demonstrated the effectiveness of two adapted Diabetes Prevention Program
(DPP) lifestyle interventions compared with usual primary care.
Subjects:
E-LITE randomized 241 overweight or obese participants with pre-diabetes and/or metabolic
syndrome to receive usual care alone (n=81) or usual care plus a coach-led (n=79)
or self-directed intervention (n=81). The interventions provided coach-led group behavioral
weight-loss treatment or a take-home, self-directed DVD using the same 12-week curriculum,
followed by 12 additional months of technology-mediated coach contact and self-monitoring
support. Participants received no further intervention after month 15. A blinded assessor
conducted 24-month visits by following the measurement protocols of the original trial.
Measurements include weight and cardiometabolic risk factors (waist circumference,
fasting plasma glucose, resting blood pressure, triglycerides, high- and low-density
lipoprotein cholesterol, total cholesterol and triglyceride to high-density lipoprotein
cholesterol ratio).
Results: At month 24, mean±s.e. changes in body
mass index (trial primary outcome) and weight (kg) from baseline were -1.9±0.3
(P=0.001) and -5.4±0.9 (P<0.001) in the coach-led intervention, and -1.6±0.3
(P=0.03) and -4.5±0.9 (P=0.001) in the self-directed intervention, compared
with -0.9±0.3 and 2.4±0.9 in the usual care group. In addition, both
interventions led to a greater percentage of participants maintaining ?7% weight loss
and sustained improvements in waist circumference and fasting plasma glucose levels
than usual care.
Conclusion: This study shows sustained benefits of the
two primary care-based, technology-mediated DPP lifestyle interventions. The findings
warrant replication in long-term studies involving diverse populations.