Living Well With Diabetes: 24-Month Outcomes From a Randomized Trial of Telephone-Delivered Weight Loss and Physical Activity Intervention to Improve Glycemic Control
Living Well With Diabetes: 24-Month Outcomes From a Randomized Trial of Telephone-Delivered Weight Loss and Physical Activity Intervention to Improve Glycemic Control
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DOI：
10.2337/dc13-2427
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发表时间：
2014-08-01
期刊：
影响因子：
16.2
通讯作者：
Reeves, Marina M.
中科院分区：
文献类型：
--
作者：
Eakin, Elizabeth G.;Winkler, Elisabeth A.;Reeves, Marina M.
目的评估电话传递的行为减肥和身体活动干预对澳大利亚2型糖尿病初级保健患者的有效性。研究设计与方法电话咨询（n = 151）与常规护理（n = 151）的随机对照试验。本文报告了18个月（干预结束）和24个月（维持）的主要结局，包括体重、中高强度体力活动（MVPA；通过加速度计）和HbA（1c）水平。次要结局包括膳食能量摄入和饮食质量、腰围、血脂水平和血压。数据通过调整后的线性混合模型进行分析，并对缺失数据进行多次输入。结果与常规护理参与者相比，电话咨询参与者在体重减轻（基线体重的相对比率[RR]为-1.42% [95% CI为-2.54至-0.30%]）、MVPA （RR为1.42 [95% CI为1.06-1.90]）、饮食质量（RR为2.72 [95% CI为0.55-4.89]）和腰围（-1.84 cm [95% CI为-3.16至-0.51 cm]）或其他心脏代谢指标方面取得了适度但显著的改善，但在HbA（1c）水平（RR为0.99 [95% CI为0.96-1.02]）或其他心脏代谢指标方面没有改善。在维持期间，没有一项结果显示出明显的变化/恶化。然而，只有MVPA的干预效果在24个月时仍有统计学意义。结论体重减轻和行为改变的适度改善，但缺乏心脏代谢指标的变化，可能限制了这种方法的实用性、可扩展性和可持续性。
OBJECTIVETo 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 METHODSPragmatic 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 HbA(1c) 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.RESULTSRelative to usual-care participants, telephone counseling participants achieved modest, but significant, improvements inweight 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 HbA(1c) 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.CONCLUSIONSThe 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.