Results from a retrospective study indicate clear benefits for people with diabetes enrolling in a program designed to encourage lifestyle and behavior change. The study saw that participants who joined the program were less likely to have eye and renal disease, had reduced weight, and better glucose control.
29 million people in America are diagnosed with diabetes, and another 87 million are considered people with pre-diabetes according to the CDC.1 In 2013 diabetes was the seventh leading cause of death in the US. In the U.S. more than 20% of health care costs are spent on diabetes care, over $245 billion in 2012.1,2 With such a significant burden both for patient and the health care system, preventative care for diabetes is essential. Lifestyle change programs in clinical trials have been shown to reduce concerns associated with pre-diabetes such as increased insulin sensitivity, abdominal fat, and inactivity.2 However, behavior and lifestyle interventions are challenging to implement outside of a clinical trial.2 The Veterans Association MOVE! Program was the largest government implemented lifestyle modification program in the U.S. and involved 10 modules addressing nutrition, portion sizes, walking, and physical activity and other curriculum focused to help improve weight management.2
A recent longitudinal retrospective cohort study lead by Sandra L. Jackson published in the Journal of Diabetes and Its Complications in 2017 evaluated the incidence of diabetic eye disease, renal disease, anti-diabetic medication usage, and glycemic control in people with diabetes who were enrolled in MOVE! as compared to similar patients who were not enrolled. The study included over 400,000 participants under the age of 70 (average age was 58), eligible to join the MOVE! program based on BMI (average was 34 kg/m2) and a diagnosis of diabetes at baseline.2
After statistical analysis, and controlling for gender, race and age, those who participated in the MOVE! program had a lower body weight (−0.6 kg), lower serum glucose and reduced HbA1c (−0.1%) levels 12 months after participation in the program. Additionally those in the program had a lower incidence of eye disease, renal disease and reduced medication use (hazard ratios 0.80, 0.89, and 0.82 respectively).2
Why is this Clinically Relevant?
Based on this long-term study it appears that implementation of lifestyle programs as a part of standard of care in diabetes and prediabetes can improve health outcomes and potentially reduce the health care burden for both patient and health care system. One year after participation, participants of the MOVE! program had
- Reduced body weight
- Lowered HbA1c levels
- Decreased medication intensification
- Reduced incidence of eye and renal disease
1 Diabetes. Centers for Disease Control and Prevention. https://www.cdc.gov/chronicdisease/resources/publications/aag/diabetes.htm. Published July 25, 2016. Accessed July 14, 2017.
2 Jackson SL, Staimez LR, Safo S, et al. Participation in a National Lifestyle Change Program is associated with improved diabetes Control outcomes. Journal of Diabetes and its Complications. 2017. doi:10.1016/j.jdiacomp.2017.06.001.