Lifestyle intervention in type 2 diabetes can have long-term effect
Author: Louise Prime
People with type 2 diabetes who took part in a behavioural intervention showed an increase in physical activity and decrease in sedentary time compared with those who had had standard care, sustained for at least three years, research from Italy has found. The authors of the study*, published in JAMA, also reported that cardiorespiratory fitness and lower body strength improved significantly in the behavioural intervention group, whereas all measures of fitness worsened in the standard care group.
The research team, led from La Sapienza University in Rome, pointed out that adherence to physical activity and exercise recommendations is generally difficult, and until now there has been no definitive evidence that changes in physical activity or sedentary behaviour can be maintained in the long-term in people with type 2 diabetes; they decided to investigate.
They recruited 300 physically inactive and sedentary men and women (mean age 61.6 years) with type 2 diabetes from three outpatient diabetes clinics in Rome, whom they randomised to receive either a behavioural intervention or standard care for three years. All participants received usual care targeted to meet American Diabetes Association guideline recommendations, but those in the behavioural intervention group received one individual theoretical counselling session and eight individual biweekly theoretical and practical counselling sessions each year, whereas those in the standard care group received only general physician recommendations.
The researchers reported that 267 participants completed the study (133 in the intervention group and 134 in the standard care group). Over a median follow-up of 3.0 years, participants in the behavioural intervention and standard care groups accumulated, respectively, 13.8 vs. 10.5 metabolic equivalent-h/week of physical activity volume; 18.9 vs. 12.5 min/day of moderate- to vigorous-intensity physical activity; 4.6 vs. 3.8 h/day of light-intensity physical activity; and 10.9 vs. 11.7 h/day of sedentary time. All these differences between groups were statistically significant.
They noted that significant between-group differences were maintained throughout the study, although the between-group difference in moderate- to vigorous-intensity physical activity decreased during the third year from 6.5 to 3.6 min/day.
In addition, they found, the mean difference in participants in the behavioural intervention vs standard care group was significant for fasting plasma glucose, systolic blood pressure, total coronary heart disease (CHD) 10-year risk score, and fatal CHD 10-year risk score over time. Furthermore, the between-group mean difference in change from baseline was significant for total stroke risk score after two years and HbA1c, fasting plasma glucose, 10-year total CHD risk score, 10-year fatal CHD risk score, and total stroke after three years. Throughout the study, changes in medication were similar in participants in both groups and insulin dosage did not differ between groups.
41 adverse events were reported in the behavioural intervention group and 59 in the standard care group outside of the sessions; participants in the intervention group had eight episodes of mild hypoglycaemia, three episodes of tachycardia/arrhythmia, and 19 episodes of musculoskeletal injury/discomfort during the theoretical and practical counselling sessions.
The study authors concluded: “Among patients with type 2 diabetes at three diabetes clinics in Rome who were followed up for three years, a behavioural intervention strategy compared with standard care resulted in a sustained increase in physical activity and decrease in sedentary time. Further research is needed to assess the generalisability of these findings.”
*Balducci S, D’Errico V, Haxhi J, et al. Effect of a behavioral intervention strategy on sustained change in physical activity and sedentary behavior in patients with type 2 diabetes: the IDES_2 randomized clinical trial. JAMA 2019; 321(9): 880–890. doi:10.1001/jama.2019.0922.