Impact of a Shared Medical Appointment Lifestyle Intervention on Weight and Lipid Parameters in Individuals with Type 2 Diabetes: A Clinical Pilot

Abstract

Background:There is a growing awareness that lifestyle behavior modifications may reduce weight and the atherogenic dyslipidemia associated with obesity and type 2 diabetes mellitus (T2DM).Objective:We pilot the effectiveness of a diabetes educational program combining shared medical appointments (SMAs) with an 8-week DVD-based diabetes education program emphasizing a plant-based diet in lowering weight and lipids in individuals with T2DM. This pilot also employed a nonrandomized convenience sample to explore which of the educational program's target behaviors were associated with the greatest risk factor reduction.Design:Forty-six adult patients with T2DM voluntarily self-selected to enroll in the educational quality improvement initiative run as part of a community clinical practice. Target behaviors measured weekly were (1) days with beans for breakfast, (2) days of exercise, (3) minutes of exercise per day, (4) days with light evening meals, (5) days with no evening meals, (6) days with no red meat, (7) days with plant-based diet, and (8) number of 8-ounce cups of water per day. Biometric measurements were taken at the beginning and end of the 2-month program. These included high-density lipoprotein (HDL), low-density lipoprotein (LDL), total cholesterol, and triglycerides. Weight was measured weekly. Regression analysis was performed to identify which target behaviors were associated with changes in lipids and weight.Results:There was a statistically significant (F = 2.429; df = 8.21; p < 0.05) decrease in weight (mean −8.9 lbs, or 4.05 kg, or 4.1% body weight, p < 0.01) during the 8-week study period. There was a positive trend in all lipid parameters, but none reached statistical significance with this sample. Exploratory weighted least-squares regression found that weight loss in the study group was most associated with higher water consumption (t = 3.16; p < 0.01), days per week with no evening meal (t = 3.03; p < 0.01), and days per week consuming beans for breakfast (t = 2.06; p = 0.05.Conclusions:In this pilot study, the DVD-based educational program delivered as part of an SMA was associated with significant weight loss but insignificant lipid changes. Behavior changes most closely associated with weight loss were increasing water consumption, eliminating evening meals, and increasing the consumption of beans for breakfast. These potentially important findings in this small sample suggest the need for a randomized clinical trial with a larger and planned sample.