Can lifestyle interventions improve glycemic control in people with advanced type 2 diabetes?

This study examined whether lifestyle interventions could improve control of blood glucose levels (glycemic control) in people with advanced type 2 diabetes (T2D). They determined that certain lifestyle interventions resulted in a significant decrease in HbA1c levels (a measure of glycemic control). 

T2D is associated with a high-calorie diet and lack of physical activity. Thus, lifestyle interventions are often useful. They can delay the development of T2D in people with pre-diabetes, and can reduce the need for anti-diabetes medication in people with early-stage T2D. However, little research has focused on lifestyle interventions in people with advanced T2D.

The Telemedical Lifestyle Intervention Program (TeLiPro) is a 12 week program that was used in this study. 

202 adults with advanced T2D and poor glycemic control were recruited for this study. All were overweight or obese, and all were taking at least 2 anti-diabetes drugs. 102 participants were randomly assigned to the TeLiPro group. 100 were randomly assigned to the control group. Both groups received a guide on managing T2D, a weighing scale, and a step counter. Both groups were encouraged to measure their steps and weight daily. The TeLiPro group also received a blood-glucose meter.

For the first 12 weeks the TeLiPro group were placed on a diet that included a protein-rich meal replacement, in order to achieve an initial weight-loss. The TeLiPro group also received phone calls from trained diabetes coaches for the first 12 weeks. These calls included information about T2D, anti-diabetes medication, healthy diet, and physical activity.

Both groups were followed up for a physical exam after 12 weeks of treatment, and after 26 and 52 weeks. At this time the participants also received questionnaires to assess their quality of life and eating behavior.

After 12 weeks the TeLiPro group had a significant reduction in HbA1c (average blood glucose over 3 months), but the control group did not. Average HbA1c levels fell from 8.4% to 7.3% in the TeLiPro group, but just from 8.2% to 8.0% in the control group. The TeLiPro group had an average weight loss of 6.2 kg.  They also had reductions in body mass index (measurement of weight that takes height into account) and blood pressure. No significant changes were seen in the control group for weight or blood pressure. Quality of life and eating behavior were also improved in the TeLiPro group, but not the control group. The need for anti-diabetes medication fell in the TeLiPro group, but not the control group. 

The study concluded that the TeLiPro lifestyle interventions improved glycemic control in people with advanced T2D. They also found that body weight, blood pressure, quality of life, eating behavior, and need for anti-diabetes medication were improved after TeLiPro lifestyle interventions.

This study only included patients who were overweight or obese, who had poor glycemic control, and who were taking at least two anti-diabetes drugs. Thus the results may not apply equally to all people with T2D.

Discuss lifestyle interventions in advanced T2D with your physician.