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© 2004 by the American Diabetes Association, Inc.
Clinical Care/Education/Nutrition |
Translating Lifestyle Intervention to Practice in Obese Patients With Type 2 Diabetes
Improving Control with Activity and Nutrition (ICAN) study
1 Department of Health Evaluation Sciences, University of Virginia School of Medicine, Charlottesville, Virginia
2 Department of Internal Medicine, Division of Endocrinology and Metabolism, University of Virginia School of Medicine, Charlottesville, Virginia
3 Southern Health Services, Richmond, Virginia
Address correspondence and reprint requests to Anne Wolf, Department of Health Evaluation Sciences, Box 800717, Charlottesville, VA 22908-0717. E-mail: amw6n{at}virginia.edu
OBJECTIVE—To assess the efficacy of a lifestyle intervention program that can be readily translated into clinical practice for obese patients with type 2 diabetes.
RESEARCH DESIGN AND METHODS—The study consisted of a 12-month randomized controlled trial of 147 health plan members with type 2 diabetes and obesity (BMI 
27 kg/m2). Participants were randomized to lifestyle case management or usual care. Case management entailed individual and group education, support, and referral by registered dietitians; intervention cost was $350 per person. Individuals treated with usual care received educational material. Both groups received ongoing primary care. Outcomes were difference between groups for change in weight (kilograms), waist circumference (centimeters), HbA1c, fasting lipid levels, use of prescription medications, and health-related quality of life.
RESULTS—Case management resulted in greater weight loss (P < 0.001), reduced waist circumference (P < 0.001), reduced HbA1c level (P = 0.02), less use of prescription medications (P = 0.03), and improved health-related quality of life (P < 0.001) compared with usual care. The 12-month group difference in weight loss and waist circumference was 3.0 kg (95% CI –5.4 to –0.6) and –4.2 cm (–6.8 to –1.6). HbA1c differences were greatest at 4 months (–0.59%, P = 0.006) but not significant by 12 months (–0.19%, P = 0.45). Participants in the case management group lowered their use of medications, primarily diabetes medications, by 0.8 medications per day more than participants treated with usual care (P = 0.03). In seven of nine quality-of-life domains, the case management group improved compared with usual care (P < 0.05).
CONCLUSIONS—Moderate-cost dietitian-led lifestyle case management may improve diverse health indicators among obese patients with type 2 diabetes.
Abbreviations: HRQOL, health-related quality of life • ICAN, Improving Control with Activity and Nutrition • RD, registered dietitian • SF-36, Medical Outcomes Study Short Form-36 • SHS, Southern Health Services
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