Elizabeth G Eakin1, Elisabeth A Winkler2, David W Dunstan3, Genevieve N Healy4, Neville Owen5, Alison M Marshall6, Nicholas Graves6, Marina M Reeves2. 1. School of Population Health, Cancer Prevention Research Centre, University of Queensland, Brisbane, Queensland, AustraliaBaker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia e.eakin@sph.uq.edu.au. 2. School of Population Health, Cancer Prevention Research Centre, University of Queensland, Brisbane, Queensland, Australia. 3. Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, AustraliaSchool of Sport Science, Exercise and Health, University of Western Australia, Perth, Western Australia, AustraliaSchool of Exercise and Nutrition Sciences, Deakin University, Melbourne, Victoria, AustraliaSchool of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia. 4. School of Population Health, Cancer Prevention Research Centre, University of Queensland, Brisbane, Queensland, AustraliaBaker IDI Heart and Diabetes Institute, Melbourne, Victoria, AustraliaSchool of Physiotherapy, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia. 5. School of Population Health, Cancer Prevention Research Centre, University of Queensland, Brisbane, Queensland, AustraliaBaker IDI Heart and Diabetes Institute, Melbourne, Victoria, AustraliaMelbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, AustraliaCentral Clinical School, Monash University, Melbourne, Victoria, Australia. 6. School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.
Abstract
OBJECTIVE: To evaluate the effectiveness of a telephone-delivered behavioral weight loss and physical activity intervention targeting Australian primary care patients with type 2 diabetes. RESEARCH DESIGN AND METHODS: Pragmatic randomized controlled trial of telephone counseling (n = 151) versus usual care (n = 151). Reported here are 18-month (end-of-intervention) and 24-month (maintenance) primary outcomes of weight, moderate-to-vigorous-intensity physical activity (MVPA; via accelerometer), and HbA1c level. Secondary outcomes include dietary energy intake and diet quality, waist circumference, lipid levels, and blood pressure. Data were analyzed via adjusted linear mixed models with multiple imputation of missing data. RESULTS: Relative to usual-care participants, telephone counseling participants achieved modest, but significant, improvements in weight loss (relative rate [RR] -1.42% of baseline body weight [95% CI -2.54 to -0.30% of baseline body weight]), MVPA (RR 1.42 [95% CI 1.06-1.90]), diet quality (2.72 [95% CI 0.55-4.89]), and waist circumference (-1.84 cm [95% CI -3.16 to -0.51 cm]), but not in HbA1c level (RR 0.99 [95% CI 0.96-1.02]), or other cardio-metabolic markers. None of the outcomes showed a significant change/deterioration over the maintenance period. However, only the intervention effect for MVPA remained statistically significant at 24 months. CONCLUSIONS: The modest improvements in weight loss and behavior change, but the lack of changes in cardio-metabolic markers, may limit the utility, scalability, and sustainability of such an approach.
RCT Entities:
OBJECTIVE: To evaluate the effectiveness of a telephone-delivered behavioral weight loss and physical activity intervention targeting Australian primary care patients with type 2 diabetes. RESEARCH DESIGN AND METHODS: Pragmatic randomized controlled trial of telephone counseling (n = 151) versus usual care (n = 151). Reported here are 18-month (end-of-intervention) and 24-month (maintenance) primary outcomes of weight, moderate-to-vigorous-intensity physical activity (MVPA; via accelerometer), and HbA1c level. Secondary outcomes include dietary energy intake and diet quality, waist circumference, lipid levels, and blood pressure. Data were analyzed via adjusted linear mixed models with multiple imputation of missing data. RESULTS: Relative to usual-care participants, telephone counseling participants achieved modest, but significant, improvements in weight loss (relative rate [RR] -1.42% of baseline body weight [95% CI -2.54 to -0.30% of baseline body weight]), MVPA (RR 1.42 [95% CI 1.06-1.90]), diet quality (2.72 [95% CI 0.55-4.89]), and waist circumference (-1.84 cm [95% CI -3.16 to -0.51 cm]), but not in HbA1c level (RR 0.99 [95% CI 0.96-1.02]), or other cardio-metabolic markers. None of the outcomes showed a significant change/deterioration over the maintenance period. However, only the intervention effect for MVPA remained statistically significant at 24 months. CONCLUSIONS: The modest improvements in weight loss and behavior change, but the lack of changes in cardio-metabolic markers, may limit the utility, scalability, and sustainability of such an approach.
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