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Sustained Weight Loss, Glucose Control With Lifestyle Intervention in Obese Patients With Type 2 Diabetes: Presented at ECO

By Shazia Qureshi

AMSTERDAM, Netherlands -- May 9, 2009 -- In obese patients with type 2 diabetes who were taking insulin or oral diabetes medications, an intensive lifestyle intervention resulted in a sustained weight loss of 10.1% after 1 year, researchers reported here May 7 at the 17th European Congress on Obesity (ECO).

In addition, blood glucose control was improved, as shown by a mean 0.74-point reduction in glycosylated haemoglobin (Hb A1C) and reductions in the required dose of metformin or insulin.

Mirjam Lips, MD, a PhD student in the Department of Endocrinology, Leiden University Medical Centre, Leiden, Netherlands, and researcher at the Dutch Obesity Clinic, Hilversum, Netherlands, presented the results of this 1-year study, noting that "pharmacotherapy is often unsuccessful to achieve glucose control and multidisciplinary treatment should be encouraged."

The study included 163 patients with obesity and type 2 diabetes, of whom 60 were using insulin and 103 were taking metformin either alone or with other oral diabetes medications.

Baseline characteristics of all patients included a mean age of 53.9 years, mean body mass index (BMI) of 38.7 kg/m², mean Hb A1C of 7.3%, and mean blood glucose concentration of 8.0 mmol/L.

The lifestyle intervention began with once-weekly sessions for the first 15 weeks, then sessions every 3 weeks for weeks 15 to 65. Sessions included nutritional, psychological, and physical activity counselling from a multidisciplinary team of care providers.

The psychological sessions were group sessions. The nutritional advice was offered in individual as well as group sessions and included calorie restriction (1,200-1,500 kcal/day) plus individualised menu plans, but not meal replacements.

At week 65, 87% of patients were still participating in the study.

The investigators found that mean body weight fell by 10.1%, from 112.3 kg at baseline to 100.9 kg at 65 weeks (P < .001).

Mean BMI also was significantly reduced to 35.2 kg/m² (P < .001 vs baseline), a mean reduction of 3.5 kg/m². Mean waist circumference fell from 122.8 to 107.4 cm.

Hb A1C fell to 6.56% at 65 weeks (P < .001 vs baseline). Other signs of improved blood glucose control included a drop in the mean daily dose of metformin from 1,610 to 1,160 mg/day among the 103 patients who used it, and a drop in the mean daily dose of insulin from 111 to 53 units/day among the 60 patients taking insulin.

Additionally, 22.7% of patients taking oral diabetes medications at the start of the study no longer needed them at 65 weeks, and 9.8% of insulin patients were no longer taking insulin.

Dr. Lips concluded that "long-term lifestyle intervention should be a main component of the treatment of obese patients with type 2 diabetes." She is currently evaluating the 2-year follow-up data.

The study was funded by VGZ Zorgverzekering, a health insurance company in the Netherlands.

[Presentation title: Lifestyle Intervention on Top of Pharmacological Treatment in Obese Type 2 Diabetes Mellitus Patients. Abstract T5:RS1.4]

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