Diabetes Management: Intensive Lifestyle Interventions for Patients with Type 2 Diabetes
Findings and Recommendations
The Community Preventive Services Task Force (CPSTF) recommends intensive lifestyle interventions for patients with type 2 diabetes to improve glycemic control and reduce risk factors for cardiovascular disease.
The full CPSTF Finding and Rationale Statement and supporting documents for Diabetes Prevention and Control: Intensive Lifestyle Interventions for Patients with Type 2 Diabetes are available in The Community Guide Collection on CDC Stacks.
Intervention
Intensive lifestyle interventions provide ongoing counseling, coaching, or individualized guidance to patients with type 2 diabetes to help them change their diet, level of physical activity, or both. Patients must interact with program staff multiple times for a period of six months or longer. Dietary components may include tailored advice, and physical activity components may include structured and personalized guidance or supervised exercise training. Programs may have weight loss goals or include additional components related to weight loss or maintenance.
About The Systematic Review
The CPSTF uses recently published systematic reviews to conduct accelerated assessments of interventions that could provide program planners and decision-makers with additional, effective options. The following published review was selected and evaluated by a team of specialists in systematic review methods, and in research, practice, and policy related to diabetes management.
Huang XL, Pan JH, Chen D, Chen J, Hu TT. Efficacy of lifestyle interventions in patients with type 2 diabetes: A systematic review and meta-analysis. European Journal of Internal Medicine 2016;27;37-47.
The systematic review and meta-analysis included 17 studies (Huang et al., 2016; search period through July 15, 2014). The CPSTF finding is based on results from a subset of 7 studies that evaluated intensive physical activity programs (5 studies) and intensive dietary programs (3 studies).
Study Characteristics
- All included studies were randomized controlled trials
- Evaluated interventions provided a median of 11 sessions that were individual (3 studies) or a combination of individual and group sessions (4 studies)
- Studies evaluated interventions that provided patients specific, tailored instruction on lifestyle changes through multiple interactions over extended periods of time
- The median intervention duration was 12 months. All 7 studies established clear goals for patients’ dietary changes (3 studies), physical activity levels (5 studies), or weight loss (2 studies)
Summary of Results
The systematic review included 7 studies.
Dietary Programs (3 studies)
- Intensive dietary programs led to favorable changes in reported outcomes including significant decreases in blood glucose (A1c), systolic blood pressure, and diastolic blood pressure, and a significant increase in HDL cholesterol
Physical Activity Programs (5 studies)
- Intensive physical activity programs led to favorable changes in reported outcomes including significant decreases in blood glucose (A1c) and diastolic blood pressure
Summary of Economic Evidence
Huang et al. did not consider evidence or information on the economic benefits of these interventions. An economic evaluation of the Look AHEAD trial reported lower health-care costs over 10 years.
Applicability
Based on evidence from the review, the CPSTF finding is applicable to interventions offered to adults with type 2 diabetes through healthcare settings in the United States.
Evidence Gaps
The CPSTF identified several areas that have limited information. Additional research and evaluation could help answer the following questions and fill remaining gaps in the evidence base. (What are evidence gaps?)
- How does effectiveness vary between specific programs in different populations (e.g., by race, SES, educational attainment, age, cognitive or physical disabilities)?
- How effective are programs delivered through the internet, email, apps, or social networking?
- What is the relative effectiveness of individual and group sessions?
- What structures and systems are needed to maintain program effectiveness and help participants continue their improvements to diet and physical activity following program completion?
- What are long-term effects on participants’ glycemic control, weight loss, cardiovascular disease risk factors, morbidity, and mortality?
- What are program attrition rates? Why do participants drop out, and how can they be retained?
- Are these interventions effective with children and adolescents?
Implementation Considerations and Resources
The U.S. Preventive Services Task Force (USPSTF) issued the following in 2015:
The U.S. Preventive Services Task Force recommends screening for abnormal blood glucose as part of cardiovascular risk assessment in adults aged 40 to 70 years who are overweight or obese. Clinicians should offer or refer patients with abnormal blood glucose to intensive behavioral counseling interventions to promote a healthful diet and physical activity. (B recommendation: October 2015)
- This recommendation will likely increase demand for early intervention to support patients in making lifestyle changes and adopting long-term self-management behaviors
- Close coordination between healthcare systems, healthcare providers, and community-based programs will likely be an essential element of sustainable community-based services
- Patients with, or at increased risk for, cardiovascular disease may need pre-intervention assessments before initiating changes in physical activity, diet, and weight management
- Participants may be at increased risk for injuries associated with changes in physical activity. This risk can be reduced if walking is emphasized as the primary mode of physical activity with gradually increasing activity levels added as tolerated
Crosswalks
Healthy People 2030 includes the following objectives related to this CPSTF recommendation.