Sandra L Jackson1, Lisa R Staimez2, Sandra Safo3, Qi Long3, Mary K Rhee4, Solveig A Cunningham2, Darin E Olson4, Anne M Tomolo5, Usha Ramakrishnan2, Venkat K M Narayan2, Lawrence S Phillips4. 1. Atlanta VA Medical Center, Decatur, GA; Nutrition and Health Sciences, Graduate Division of Biological and Biomedical Sciences, Emory University, Atlanta, GA. Electronic address: sandrajackson@alum.emory.edu. 2. Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA. 3. Atlanta VA Medical Center, Decatur, GA; Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA. 4. Atlanta VA Medical Center, Decatur, GA; Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, Atlanta, GA. 5. Atlanta VA Medical Center, Decatur, GA; Division of General Medicine and Geriatrics, Department of Medicine, Emory University School of Medicine, Atlanta, GA.
Abstract
AIMS: Clinical trials show lifestyle change programs are beneficial, yet large-scale, successful translation of these programs is scarce. We investigated the association between participation in the largest U.S. lifestyle change program, MOVE!, and diabetes control outcomes. METHODS: This longitudinal, retrospective cohort study used Veterans Health Administration databases of patients with diabetes who participated in MOVE! between 2005 and 2012, or met eligibility criteria (BMI ≥25kg/m2) but did not participate. Main outcomes were diabetic eye disease, renal disease, and medication intensification. RESULTS: There were 400,170 eligible patients with diabetes, including 87,366 (22%) MOVE! PARTICIPANTS: Included patients were 96% male, 77% white, with mean age 58years and BMI 34kg/m2. Controlling for baseline measurements and age, race, sex, BMI, and antidiabetes medications, MOVE! participants had lower body weight (-0.6kg), random plasma glucose (-2.8mg/dL), and HbA1c (-0.1%) at 12months compared to nonparticipants (each p<0.001). In multivariable Cox models, MOVE! participants had lower incidence of eye disease (hazard ratio 0.80, 95% CI 0.75-0.84) and renal disease (HR 0.89, 95% CI 0.86-0.92) and reduced medication intensification (HR 0.82, 95% CI 0.80-0.84). CONCLUSIONS: If able to overcome participation challenges, lifestyle change programs in U.S. health systems may improve health among the growing patient population with diabetes. Published by Elsevier Inc.
AIMS: Clinical trials show lifestyle change programs are beneficial, yet large-scale, successful translation of these programs is scarce. We investigated the association between participation in the largest U.S. lifestyle change program, MOVE!, and diabetes control outcomes. METHODS: This longitudinal, retrospective cohort study used Veterans Health Administration databases of patients with diabetes who participated in MOVE! between 2005 and 2012, or met eligibility criteria (BMI ≥25kg/m2) but did not participate. Main outcomes were diabetic eye disease, renal disease, and medication intensification. RESULTS: There were 400,170 eligible patients with diabetes, including 87,366 (22%) MOVE! PARTICIPANTS: Included patients were 96% male, 77% white, with mean age 58years and BMI 34kg/m2. Controlling for baseline measurements and age, race, sex, BMI, and antidiabetes medications, MOVE! participants had lower body weight (-0.6kg), random plasma glucose (-2.8mg/dL), and HbA1c (-0.1%) at 12months compared to nonparticipants (each p<0.001). In multivariable Cox models, MOVE! participants had lower incidence of eye disease (hazard ratio 0.80, 95% CI 0.75-0.84) and renal disease (HR 0.89, 95% CI 0.86-0.92) and reduced medication intensification (HR 0.82, 95% CI 0.80-0.84). CONCLUSIONS: If able to overcome participation challenges, lifestyle change programs in U.S. health systems may improve health among the growing patient population with diabetes. Published by Elsevier Inc.
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