Implementing a 3-month lifestyle modification program in patients who are overweight or obese with prediabetes resulted in improvements in weight, eating habits, physical activity level, and A1c, according to study results published in the Journal of the American Association of Nurse Practitioners.1 

Montgomery County, Alabama, has one of highest rates of obesity (35%) and diabetes (13%) in the nation, with up to 7% of the population at risk of developing diabetes.2 To improve access, outcomes, and quality of care in patients with prediabetes, the researchers at a clinic in Montgomery county developed an onsite, evidence-based, lifestyle change program.

Patients aged 18 to 80 years with a diagnosis of prediabetes, a body mass index of ≥25 , and a glycated hemoglobin (HbA1c) between 5.7% and 6.4% were included in the study. Eligible patients were recruited via chart review and referrals from providers; a total of 33 patients enrolled in the 3-month program and 24 attended prediabetes sessions 1, 2, and 3 and the 3-month follow-up appointment. The content of each group session was based on the first 5 sessions of the Prevent T2 curriculum, titled, “Introduction,” “Get Active,” “Track Your Activity,” “Eat Well to Prevent T2,” and “Track Your Food.”

The weight loss goal for the program was ≥2.5% of body weight within 3 months. The goal of increased routine activity was chosen based on the Prevent T2’s goal of performing at least 150 minutes of moderate- to high-intensity physical activity every week. Eating habits and physical activity levels were evaluated using the Rapid Eating Assessment for Patients (REAP) and the REAP-Physical Activity (REAP-PA) tool, a 27-item questionnaire that evaluates food intake and measures of physical activity.

Of the 24 patients who attended all 3 prediabetes sessions, 2 patients missed 1 prediabetes session, and 1 patient missed 2 sessions. The average patient post-intervention weight (95.2 kg) was significantly lower than pre-intervention weight (99.3 kg; average weight loss, 4.0±4.2 kg). Mean weight loss was greater in patients with higher education levels. Average weight loss post-intervention was greater in white patients (7.8%) compared with black patients (2.7%). A total of 14 of the 24 patients (58%) lost ≥2.5% of baseline weight; 4 patients showed an increase in weight.

There was not a statistically significant change in HbA1c levels during the study. The pre-intervention HbA1c mean was 6.0% compared with a post-intervention mean of 5.9%. However, there were significant changes in REAP and REAP-PA scores: mean pre-intervention REAP score was 55.5 compared with 45.0 post-intervention and mean pre-intervention REAP-PA was 2.2 compared with 1.6 post-intervention.

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“Overall, the implementation of a 3-month lifestyle modification program showed improvement in the clinical outcome measures of interest, weight, REAP score, REAP PA, and A1c, although the decrease in A1c was not statistically significant,” the researchers concluded.

References

1. Daftarian Z, Bowen PG. Improving outcomes in patients with prediabetes through a lifestyle modification program. J Am Assoc Nurse Pract. 2020;32(3):244-251.

2. Centers for Disease Control and Prevention. Diagnosed diabetes percentage: 2016 Alabama. https://gis.cdc.gov/grasp/diabetes/DiabetesAtlas.html, Accessed March 20, 2020.