Adding dietary component bumps benefits of group visits in T2D

  • Yancy WS & al.
  • JAMA Intern Med
  • 4 nov. 2019

  • de Miriam Tucker
  • Clinical Essentials
El acceso al contenido completo es sólo para profesionales sanitarios registrados. El acceso al contenido completo es sólo para profesionales sanitarios registrados.

Takeaway

  • Adding intensive weight management (WM) via low-carbohydrate nutrition counseling to group medical visits (GMVs) improved clinical outcomes beyond HbA1c lowering in type 2 diabetes (T2D).

Why this matters

  • GMVs typically improve HbA1c but may also lead to weight gain and hypoglycemia if accomplished via medication intensification.

Study design

  • Clinical trial of 263 participants with T2D randomly assigned to 9 GMVs with counseling and medication optimization or same plus WM via low-carbohydrate diet counseling (total 13 visits).
  • Analyses conducted at 48 weeks.
  • Funding: US Department of Veterans Affairs.

Key results

  • WM+GMV was noninferior to GMV-only for HbA1c (estimated mean difference, −0.1%; 95% CI, −0.5% to 0.2%) and not superior (P=.44).
  • From baseline, HbA1c decreased:
    • −0.9% (95% CI, −1.2% to −0.6%) with WM+GMV vs
    • −0.8% (95% CI, −1.0% to −0.5%) with GMV-only.
  • Significantly fewer hypoglycemic events in WM+GMV participants vs GMV-only (incidence rate ratio, 0.49; P<.001>
  • Estimated mean number of hypoglycemic events: 3.2 (1/16 weeks) vs 6.6 (1/8 weeks).
  • Mean estimated weight loss was 3.7 kg (P<.001 greater with wm kg vs gmv-only>

    Limitations

    • Meeting frequency differed in the 2 groups during first 16 weeks.
    • Clinicians could not feasibly be blinded.
    • Mean weight changes were modest with WM+GMV.
    • Neither group met target HbA1c levels.
    • Low enrollment.