Are behavioural approaches feasible and effective in the treatment of type 2 diabetes? A propensity score analysis vs. prescriptive diet

Forlani, Gabriele; Lorusso, C.; Moscatiello, Simona; Ridolfi, Valentina; Melchionda, Nazario; Domizio, Silvia Di; Marchesini, Giulio

doi:10.1016/j.numecd.2008.06.004

Cited by 19 publications

(24 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Secondary outcomes were improved metabolic control in diabetes (0.3% reduction of HbA1c) and increased physical fitness (10% increase in the 6-min walk test - 6MWT). The target of 10 MET-hour/week corresponds to approximately 150 min fast/very fast walking, as from the Diabetes Prevention Program target [10], Italian Standards of diabetes care [18], and our own lifestyle modification programs [19]. The end-points were tested at 3- and 6-month follow-up.…”

Section: Methodsmentioning

confidence: 99%

A standard ballroom and Latin dance program to improve fitness and adherence to physical activity in individuals with type 2 diabetes and in obesity

Mangeri¹,

Montesi

Forlani

et al. 2014

Diabetol Metab Syndr

View full text Add to dashboard Cite

ObjectiveTo test the effectiveness of a dance program to improve fitness and adherence to physical activity in subjects with type 2 diabetes and obesity.Research Design and MethodsFollowing a motivational interviewing session, 100 subjects with diabetes and/or obesity were enrolled either in a dance program (DP, n = 42) or in a self-selected physical activity program (SSP, n = 58), according to their preferences. Outcome measures were reduced BMI/waist circumference, improved metabolic control in type 2 diabetes (−0.3% reduction of HbA1c) and improved fitness (activity expenditure >10 MET-hour/week; 10% increase in 6-min walk test (6MWT)). Target achievement was tested at 3 and 6 months, after adjustment for baseline data (propensity score).ResultsAttrition was lower in DP. Both programs significantly decreased body weight (on average, −2.6 kg; P < 0.001) and waist circumference (DP, −3.2 cm; SSP, −2.2; P < 0.01) at 3 months, and the results were maintained at 6 months. In DP, the activity-related energy expenditure averaged 13.5 ± 1.8 MET-hour/week in the first three months and 14.1 ± 3.0 in the second three-month period. In SSP, activity energy expenditure was higher but highly variable in the first three-month period (16.5 ± 13.9 MET-hour/week), and decreased in the following three months (14.2 ± 12.3; P vs. first period < 0.001). At three months, no differences in target achievement were observed between groups. After six months the odds to attain the MET, 6MWT and A1c targets were all significantly associated with DP.ConclusionDance may be an effective strategy to implement physical activity in motivated subjects with type 2 diabetes or obesity (Clinical trial reg. no.NCT02021890, clinicaltrials.gov).

show abstract

Section: Methodsmentioning

confidence: 99%

A standard ballroom and Latin dance program to improve fitness and adherence to physical activity in individuals with type 2 diabetes and in obesity

Mangeri¹,

Montesi

Forlani

et al. 2014

Diabetol Metab Syndr

View full text Add to dashboard Cite

show abstract

“…Notably, the probability to reach the weight loss target of 5% was rather high also in subjects on SC (24%), which explain the lack of statistical difference when compared to BT. Per protocol, two behavioural programmes of different intensity are offered to patients with T2DM in poor metabolic control at our department; they were reported to facilitate metabolic control as well as weight loss and to retard insulin treatment . A reanalysis of those historical data showed that ENE produced a weight loss of 4% at 1 year (vs 14% in the present series, P = 0.051) and 9% at 2 years (vs 27%, P < 0.05), whereas CBT resulted in a weight loss of 18% and 20%, respectively .…”

Section: Discussionmentioning

confidence: 60%

“…Their baseline values are reported in Table . According to our procedures, following motivational interviewing, all patients first seen inside the centre are invited to take part in structured behavioural programmes, modulated according to the severity of their weight excess and unhealthy eating pattern (see below) . At any follow‐up visit, patients receive motivational reinforcement on lifestyle changes and adherence to healthy diet and habitual physical activity, and the proposal to enter a structured programme is repeated in the presence of insufficient metabolic control.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Combination of GLP‐1 receptor agonists and behavioural treatment in type 2 diabetes elicits synergistic effects on body weight: A retrospective cohort study

Petroni¹,

Montesi²,

Colosimo³

et al. 2019

Endocrino Diabet & Metabol

View full text Add to dashboard Cite

Aims Intensification of type 2 diabetes (T2DM) treatment with GLP‐1 receptor agonists (GLP‐1RAs) promotes weight loss. We aimed to determine the synergistic effect of behavioural programmes on body weight on top of GLP‐1RA treatment. Materials and methods We retrospectively analysed the time course of 328 individuals with T2DM starting GLP‐1RA treatment because of insufficient metabolic control. In 29, a structured programme of elementary nutritional counselling was also implemented (elementary nutritional education [ENE]‐5 group sessions), whereas 53 entered a programme of cognitive‐behavioural treatment (CBT‐12 group sessions). Both programmes were completed within 6 months of switching to GLP‐1RAs. Data of body weight and metabolic control were followed up to 2 years as part of regular follow‐up. Weight loss targets (≥10% and ≥5%) and metabolic target (HbA1c < 7%) were analysed by Cox regression model in comparison with standard care (SC, N = 244). Results Body weight remarkably decreased following both behavioural programmes, with significant differences compared with SC at 2 years (CBT, 8.5 ± 5.9% vs 6.3 ± 6.9 in ENE and only 3.1 ± 5.7 in SC; P < 0.001 and P = 0.045 vs CBT and ENE, respectively). The 10% weight loss was achieved and maintained in approximately 30% of cases during follow‐up, and an additional 35% of cases lost between 5% and 10%. Data were consistent between behavioural programmes, after adjustment for confounders, including initial body weight (logreg Mantel‐Cox: ENE vs SC, P < 0.01; CBT vs SC, P < 0.001). No differences in metabolic control were detected between groups. Conclusions Initiation of GLP‐1RA treatment provides an opportunity for addressing patients' needs of weight control. By producing initial weight loss, patients' motivation and self‐efficacy are expected to increase and adherence to long‐term lifestyle changes might be more easily attained.

show abstract

“…CBT has been extensively investigated in metabolic diseases, namely in obesity (27), in subjects at risk (14,15) or with overt diabetes in the community (28), as well as in subjects with mild hypertension to prevent progression to organ disease (16). In all cases, CBT was effective, and possibly more effective and long lasting than drug treatment.…”

Section: Discussionmentioning

confidence: 99%

Cognitive‐Behavioral Treatment of Nonalcoholic Fatty Liver Disease: A Propensity Score‐Adjusted Observational Study

Moscatiello

Luzio

Bugianesi

et al. 2011

Obesity

View full text Add to dashboard Cite

The effectiveness of cognitive‐behavior treatment (CBT) in nonalcoholic fatty liver disease (NAFLD), largely related to overweight/obesity and considered the hepatic expression of the metabolic syndrome (MS), has so far been tested in very limited samples. In a tertiary referral center, consecutively observed NAFLD subjects were offered a CBT program aimed at weight loss and increased physical activity, based on 13 group sessions; 68 cases entered the treatment protocol, those who refused (n = 82) were given recommendations for diet and physical activity. Treatment goals (weight loss ≥7% initial body weight, normalization of liver enzymes, and improved parameters of MS) were tested by logistic regression at 6 months (all cases) and at 2 years, both on intention‐to‐treat and in completers (Diet, 78; CBT, 65). The results were adjusted for the propensity score of attending the CBT program, based on civil, anthropometric and clinical variables. At baseline the CBT group had a larger prevalence of obesity and more severe insulin resistance (homeostasis model assessment (HOMA)). At follow‐up, CBT was associated with a higher probability of weight loss and normal liver enzymes (6‐month: odds ratio (OR), 2.56; 95% confidence interval (CI), 1.15–5.69; 2‐year intention‐to‐treat: OR, 3.57, 95% CI, 1.59–8.00), after adjustment for propensity and changes in body weight. A similar trend was observed in the outcome goals of insulin resistance and the score of MS, which were both reduced. In conclusion, subjects with NAFLD participating in a CBT program significantly improve their general and liver parameters. The beneficial effects are largely maintained at 2‐year follow‐up, in keeping with the lifestyle‐related pathogenesis of disease.

show abstract

Are behavioural approaches feasible and effective in the treatment of type 2 diabetes? A propensity score analysis vs. prescriptive diet

Cited by 19 publications

References 33 publications

A standard ballroom and Latin dance program to improve fitness and adherence to physical activity in individuals with type 2 diabetes and in obesity

A standard ballroom and Latin dance program to improve fitness and adherence to physical activity in individuals with type 2 diabetes and in obesity

Combination of GLP‐1 receptor agonists and behavioural treatment in type 2 diabetes elicits synergistic effects on body weight: A retrospective cohort study

Cognitive‐Behavioral Treatment of Nonalcoholic Fatty Liver Disease: A Propensity Score‐Adjusted Observational Study

Contact Info

Product

Resources

About