University of Virginia Health System

For more information, contact Bob Beard at 434-982-4490.

July 12, 2004

TYPE 2 DIABETICS CAN LOSE POUNDS, TAKE LESS MEDICATION WITH DIETICIAN SUPPORT, SAYS NEW UVa STUDY

The study, published in the July issue of the journal Diabetes Care, concluded that a case management approach led by registered dietitians can improve the health of obese people with type 2 diabetes at a modest cost.

Researchers at U.Va. randomized obese patients with type 2 into a lifestyle case management group and a usual care group. All patients volunteered for the study.

The lifestyle case management group received individual and group counseling and education on diet and physical activity, plus support and referrals by one registered dietitian case manager. The usual care group received educational material only. Both groups received usual medical care.

The results showed that, over one year, the case management group lost an average of 5.3 pounds and 2.2 inches in their waist size. Most weight loss happened when the patients had more frequent contact with the dietitian case managers. This group also took fewer diabetes medications per day than usual care patients, especially insulin and sulfonyluria, and reported a greater sense of well-being.

The usual care group, however, gained an average of 1.3 pounds, while waist size was little changed. (Some in that group lost up to one-half inch in their waist size.)

“Both public health and clinical interventions are needed to stem the epidemic of obesity and diabetes,” said Anne Wolf, an instructor in the Department of Health Evaluation Sciences at U.Va., who along with other researchers at the Department co-authored the study with scientists at U.Va.’s Division of Endocrinology and Metabolism. “If we continue to treat diabetics without a sustainable lifestyle component, they’re likely to experience what some in the usual care group experienced: weight gain, increased waist circumference and lower quality of life, despite higher levels of medications.”

The case management approach exists in the health care system today, Wolf stressed, and  “this study suggests that it can be altered to focus on lifestyle issues such as diet and physical activity and be implemented at a reasonable cost to the health insurance industry.”  Case management by a dietitian in the study cost $350 per patient per year.

According to the American Diabetes Association, type 2 is the most prevalent form of diabetes and affects about 18 million Americans. The disease occurs when the body does not produce enough insulin or ignores insulin altogether. Complications of type 2 diabetes include: heart disease, blindness, nerve damage and kidney damage.

This winter, U.Va. researchers were awarded a $3.5 million grant from the National Institutes of Health to broaden this study of diet and exercise. Four hundred Virginia residents with type 2 diabetes are being enrolled in a randomized trial in cooperation with Southern Health Services, Inc. They will be tracked for four years to document the ability of well-designed fitness and diet programs to control diabetes and obesity. Patients are being enrolled in Charlottesville, Harrisonburg, Roanoke and Richmond. 

The U.Va. study was done in partnership with Southern Health and supported by grants from the American Dietetic Association, The National Institutes of Diabetes and Digestive and Kidney Diseases (NIDDK) and the U.Va. General Clinical Research Center.

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