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Shetty S, Nandeesh NS, Shetty P. The Role of Integrated Approach to Yoga Therapy-Based Yoga Module in Improving Cardiovascular Functions and Lipid Profile in Hypertensive Patients: A Randomized Controlled Trial. Int J Yoga 2022; 15:215-221. [PMID: 36949834 PMCID: PMC10026340 DOI: 10.4103/ijoy.ijoy_107_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 11/02/2022] [Accepted: 11/04/2022] [Indexed: 01/19/2023] Open
Abstract
Background Hypertension is a growing public health problem and its optimal management is imperative. Integration of lifestyle modification and yoga with antihypertensive drugs leads to its successful management. Yoga has been shown to modulate blood pressure (BP) and lipid metabolism in individuals with hypertension. The current study is a preliminary effort to ascertain the underlying mechanisms behind it. Materials and Methods Hundred patients were screened, among which 65 who met the inclusion criteria were recruited. After baseline assessments, they were randomly allocated (1:1) to an intervention group (IG) who practiced integrated approach to yoga therapy (IAYT)-based yoga module for 6 days a week, for 3 months and a control group (CG) who received no intervention. BP, heart rate variability, and lipid profile were assessed before and after the intervention. Data acquired from 60 cases were analyzed by post-hoc analysis for multiple comparisons between the mean values. Results At the end of 3 months, within-group comparison showed significant changes (P < 0.05) in IG in all variables except triglycerides, high-density lipoprotein (HDL), and very low-density lipoprotein (LDL) while similar changes were not present in the control group. Significant differences were seen between the groups in the TC (P = 0.005), HDL (P = 0.047), non-HDL (P = 0.013), LDL (P < 0.001), LDL/HDL Ratio (P = 0.031), CHOL/HDL Ratio (P = 0.043), DBP (P < 0.001), SBP (P < 0.001), and all indices of HRV (P < 0.001). Conclusion These findings suggest that IAYT-based yoga module was effective in improving cardiovascular performance and lipid metabolism, thereby mitigating coronary artery disease risk.
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Affiliation(s)
| | - NS Nandeesh
- Department of Yoga Therapeutics, SDMCNYS, Ujire, Karnataka, India
| | - Prashanth Shetty
- Department of Yoga and Naturopathy, SDMCNYS, Ujire, Karnataka, India
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Steinsbekk A, Rygg LØ, Lisulo M, By Rise M, Fretheim A. WITHDRAWN: Group based diabetes self-management education compared to routine treatment, waiting list control or no intervention for people with type 2 diabetes mellitus. Cochrane Database Syst Rev 2015; 2015:CD003417. [PMID: 26125655 PMCID: PMC10658837 DOI: 10.1002/14651858.cd003417.pub3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The review authors of this review update are unable to continue with their work. The Cochrane Metabolic and Endocrine Disorders Review Group is seeking very experienced new authors to perform an update on this complex intervention review. At June 2015, this review has been withdrawn. This review is out of date although it is correct as the date of publication. The latest version is available in the 'Other versions' tab on the Cochrane Library, and may still be useful to readers. The editorial group responsible for this previously published document have withdrawn it from publication.
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Affiliation(s)
- Aslak Steinsbekk
- Norwegian University of Science and Technology, MTFSDepartment of Public Health and General PracticeTrondheimNorwayN‐7489
| | - Lisbeth Ø. Rygg
- Norwegian University of Science and Technology, MTFSDepartment of Public Health and General PracticeTrondheimNorwayN‐7489
| | - Monde Lisulo
- Norwegian University of Science and Technology, MTFSDepartment of Public Health and General PracticeTrondheimNorwayN‐7489
| | - Marit By Rise
- Norwegian University of Science and Technology, MTFSDepartment of Public Health and General PracticeTrondheimNorwayN‐7489
| | - Atle Fretheim
- Norwegian Knowledge Centre for the Health ServicesGlobal Health UnitOsloNorway
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Brennan L, Murphy KD, Shaw KA, McKenzie JE. WITHDRAWN: Psychological interventions for overweight or obesity. Cochrane Database Syst Rev 2014; 2014:CD003818. [PMID: 24800726 PMCID: PMC10680412 DOI: 10.1002/14651858.cd003818.pub3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Since the last update of this review multiple changes like new methods and other standards make it necessary to withdraw this review and register a new title on the same topic. The editorial group responsible for this previously published document have withdrawn it from publication.
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Affiliation(s)
- Leah Brennan
- Monash UniversityCentre for Obesity Research and EducationLevel 6, The Alfred Centre, 99 Commercial RoadMelbourneVICAustralia3004
| | - Kylie D Murphy
- Monash UniversityCentre for Obesity Research and EducationLevel 6, The Alfred Centre, 99 Commercial RoadMelbourneVICAustralia3004
| | - Kelly A Shaw
- Tasmanian GovernmentDepartment of Health and Human Services3/25 Argyle StreetHobartTasmaniaAustralia7000
| | - Joanne E McKenzie
- Monash UniversitySchool of Public Health & Preventive MedicineThe Alfred Centre99 Commercial RoadMelbourneVictoriaAustralia3004
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Duran A, Runkle I, Matía P, de Miguel MP, Garrido S, Cervera E, Fernandez MD, Torres P, Lillo T, Martin P, Cabrerizo L, de la Torre NG, Calle JR, Ibarra J, Charro AL, Calle-Pascual AL. Family physician and endocrinologist coordination as the basis for diabetes care in clinical practice. BMC Endocr Disord 2008; 8:9. [PMID: 18671870 PMCID: PMC2518542 DOI: 10.1186/1472-6823-8-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2007] [Accepted: 07/31/2008] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND To estimate the proportion of diabetic patients (DPts) with peripheral vascular disease treated at a primary health care site after an endocrinologist-based intervention, who meet ATP III and Steno targets of metabolic control, as well as to compare the outcome with the results of the patients treated by endocrinologists. METHODS A controlled, prospective over 30-months period study was conducted in area 7 of Madrid. One hundred twenty six eligible diabetic patients diagnosed as having peripheral vascular disease between January 2003 and June 2004 were included in the study. After a treatment period of three months by the Diabetes team at St Carlos Hospital, 63 patients were randomly assigned to continue their follow up by diabetes team (Group A) and other 63 to be treated by the family physicians (FP) at primary care level with continuous diabetes team coordination (Group B). 57 DPts from Group A and 59 from Group B, completed the 30 months follow-up period. At baseline both groups were similar in age, weight, time from diagnosis and metabolic control. The main outcomes of this study were the proportion of patients meeting ATP III and Steno goals for HbA1c (%), Cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, blood pressure, albumine-to-creatinine excretion ratio (ACR), body mass index (BMI), waist circumference (WC), anti-aggregation treatment and smoking status. RESULTS At the end of the follow up, no differences were found between the groups. More than 37% of diabetic patients assigned to be treated by FP achieved a HbA1c < 6.5%, more than 50% a ACR < 30 mg/g, and more than 80% reached low risk values for cholesterol, LDL cholesterol, triglycerides, diastolic blood pressure and were anti-aggregated, and 12% remained smokers. In contrast, less than 45% achieved a systolic blood pressure < 130 mm Hg, less than 12% had a BMI < 25 Kg.m-2 (versus 23% in group A; p < 0.05) and 49%/30% (men/women) had a waist circumference of low risk. CONCLUSION Improvements in metabolic control among diabetic patients with peripheral vascular disease treated at a primary health care setting is possible, reaching similar results to the patients treated at a specialized level. Despite such an improvement, body weight control remains more than poor in both levels, mainly at primary care level. General practitioner and endocrinologist coordination care may be important to enhance diabetes management in primary care settings. TRIAL REGISTRATION Clinical Trial number ISRCTN75037597.
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Affiliation(s)
- Alejandra Duran
- Servicio de Endocrinología y Nutrición, Hospital Clínico San Carlos, Madrid, Spain
| | - Isabelle Runkle
- Servicio de Endocrinología y Nutrición, Hospital Clínico San Carlos, Madrid, Spain
| | - Pilar Matía
- Servicio de Endocrinología y Nutrición, Hospital Clínico San Carlos, Madrid, Spain
| | - Maria P de Miguel
- Servicio de Endocrinología y Nutrición, Hospital Clínico San Carlos, Madrid, Spain
| | - Sofia Garrido
- Unidad de Formación e Investigación de Atención Primaria, Área 7, Madrid, Spain
| | - Emilio Cervera
- Unidad de Formación e Investigación de Atención Primaria, Área 7, Madrid, Spain
| | - Maria D Fernandez
- Servicio de Endocrinología y Nutrición, Hospital Clínico San Carlos, Madrid, Spain
| | - Pilar Torres
- Dirección Médica, coordinación atención primaria-especializada, Hospital Clínico San Carlos, Madrid, Spain
| | - Tomas Lillo
- Dirección Médica, coordinación atención primaria-especializada, Hospital Clínico San Carlos, Madrid, Spain
| | - Patricia Martin
- Servicio de Endocrinología y Nutrición, Hospital Clínico San Carlos, Madrid, Spain
| | - Lucio Cabrerizo
- Servicio de Endocrinología y Nutrición, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Jose R Calle
- Servicio de Endocrinología y Nutrición, Hospital Clínico San Carlos, Madrid, Spain
| | - Jose Ibarra
- Servicio de Endocrinología y Nutrición, Hospital Clínico San Carlos, Madrid, Spain
| | - Aniceto L Charro
- Servicio de Endocrinología y Nutrición, Hospital Clínico San Carlos, Madrid, Spain
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Nield L, Moore HJ, Hooper L, Cruickshank JK, Vyas A, Whittaker V, Summerbell CD. Dietary advice for treatment of type 2 diabetes mellitus in adults. Cochrane Database Syst Rev 2007; 2007:CD004097. [PMID: 17636747 PMCID: PMC9039967 DOI: 10.1002/14651858.cd004097.pub4] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND While initial dietary management immediately after formal diagnosis is an 'accepted' cornerstone of treatment of type 2 diabetes mellitus, a formal and systematic overview of its efficacy and method of delivery is not currently available. OBJECTIVES To assess the effects of type and frequency of different types of dietary advice for adults with type 2 diabetes. SEARCH STRATEGY We carried out a comprehensive search of The Cochrane Library, MEDLINE, EMBASE, CINAHL, AMED, bibliographies and contacted relevant experts. SELECTION CRITERIA All randomised controlled trials, of six months or longer, in which dietary advice was the main intervention. DATA COLLECTION AND ANALYSIS The lead investigator performed all data extraction and quality scoring with duplication being carried out by one of the other six investigators independently with discrepancies resolved by discussion and consensus. Authors were contacted for missing data. MAIN RESULTS Thirty-six articles reporting a total of eighteen trials following 1467 participants were included. Dietary approaches assessed in this review were low-fat/high-carbohydrate diets, high-fat/low-carbohydrate diets, low-calorie (1000 kcal per day) and very-low-calorie (500 kcal per day) diets and modified fat diets. Two trials compared the American Diabetes Association exchange diet with a standard reduced fat diet and five studies assessed low-fat diets versus moderate fat or low-carbohydrate diets. Two studies assessed the effect of a very-low-calorie diet versus a low-calorie diet. Six studies compared dietary advice with dietary advice plus exercise and three other studies assessed dietary advice versus dietary advice plus behavioural approaches. The studies all measured weight and measures of glycaemic control although not all studies reported these in the articles published. Other outcomes which were measured in these studies included mortality, blood pressure, serum cholesterol (including LDL and HDL cholesterol), serum triglycerides, maximal exercise capacity and compliance. The results suggest that adoption of regular exercise is a good way to promote better glycaemic control in type 2 diabetic patients, however all of these studies were at high risk of bias. AUTHORS' CONCLUSIONS There are no high quality data on the efficacy of the dietary treatment of type 2 diabetes, however the data available indicate that the adoption of exercise appears to improve glycated haemoglobin at six and twelve months in people with type 2 diabetes. There is an urgent need for well-designed studies which examine a range of interventions, at various points during follow-up, although there is a promising study currently underway.
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Affiliation(s)
- L Nield
- University of Teesside, Parkside West Offices, Middlesbrough, U K, TS1 3BA.
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Aas AM, Seljeflot I, Torjesen PA, Diep LM, Thorsby PM, Birkeland KI. Blood glucose lowering by means of lifestyle intervention has different effects on adipokines as compared with insulin treatment in subjects with type 2 diabetes. Diabetologia 2006; 49:872-80. [PMID: 16555056 DOI: 10.1007/s00125-006-0205-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2005] [Accepted: 01/14/2006] [Indexed: 01/04/2023]
Abstract
AIMS/HYPOTHESIS Adipokines may be important in mediating signals from adipocytes to insulin-sensitive tissue and vasculature. We studied the effect of different glucose-lowering therapies on serum levels of plasminogen activator inhibitor-1 (PAI-1), high-sensitivity C-reactive protein (hs-CRP), TNF-alpha, leptin, adiponectin and ghrelin in patients with type 2 diabetes. SUBJECTS AND METHODS Twenty-eight patients with poorly controlled type 2 diabetes who were receiving oral hypoglycaemic agents were allocated to one of the following groups, and treated for 1 year: (1) lifestyle intervention (L); (2) insulin treatment (I); and (3) combined treatment (L+I). RESULTS Similar improvements in glycaemic control occurred in all three groups. There was a reduction in body weight of 3.0 kg (median) (95% CI -5.9 to -2.0) in group L, whereas in groups L+I and I body weight increased by 3.5 kg (95% CI 1.5-4.9) and 4.9 kg (95% CI -3.1 to 8.2), respectively. By trend analyses, group L had reduced levels of PAI-1 (p=0.002), hs-CRP (p<0.0001) and TNF-alpha (p=0.006), while no significant changes were observed in the levels of leptin or adiponectin. In group I, the median levels of PAI-1 (p=0.008), TNF-alpha (p=0.058) and leptin (p=0.004) increased. In the L+I group there was a reduction in PAI-1 levels (p=0.014) and an increase in levels of leptin (p<0.001). The differences in changes in the levels of PAI-1, hs-CRP, TNF-alpha and leptin between groups were also significant (all p<0.01). CONCLUSIONS/INTERPRETATION Improvement of glycaemic control through lifestyle intervention in type 2 diabetes had more beneficial effects on adipokine levels than when the same lowering of HbA(1c) was achieved with insulin treatment.
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Affiliation(s)
- A-M Aas
- Department of Nutrition and Dietetics, Aker University Hospital, Trondheimsveien 235, 0514, Oslo, Norway.
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Deakin T, McShane CE, Cade JE, Williams RDRR. Group based training for self-management strategies in people with type 2 diabetes mellitus. Cochrane Database Syst Rev 2005:CD003417. [PMID: 15846663 DOI: 10.1002/14651858.cd003417.pub2] [Citation(s) in RCA: 422] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND It has been recognised that adoption of self-management skills by the person with diabetes is necessary in order to manage their diabetes. However, the most effective method for delivering education and teaching self-management skills is unclear. OBJECTIVES To assess the effects of group-based, patient-centred training on clinical, lifestyle and psychosocial outcomes in people with type 2 diabetes. SEARCH STRATEGY Studies were obtained from computerised searches of multiple electronic bibliographic databases, supplemented by hand searches of reference lists of articles, conference proceedings and consultation with experts in the field. Date of last search was February 2003. SELECTION CRITERIA Randomised controlled and controlled clinical trials which evaluated group-based education programmes for adults with type 2 diabetes compared with routine treatment, waiting list control or no intervention. Studies were only included if the length of follow-up was six months or more and the intervention was at least one session with the minimum of six participants. DATA COLLECTION AND ANALYSIS Two reviewers independently extracted data and assessed study quality. A meta-analysis was performed if there were enough homogeneous studies reporting an outcome at either four to six months, 12-14 months, or two years, otherwise the studies were summarised in a descriptive manner. MAIN RESULTS Fourteen publications describing 11 studies were included involving 1532 participants. The results of the meta-analyses in favour of group-based diabetes education programmes were reduced glycated haemoglobin at four to six months (1.4%; 95% confidence interval (CI) 0.8 to 1.9; P < 0.00001), at 12-14 months (0.8%; 95% CI 0.7 to 1.0; P < 0.00001) and two years (1.0%; 95% CI 0.5 to 1.4; P < 0.00001); reduced fasting blood glucose levels at 12 months (1.2 mmol/L; 95% CI 0.7 to 1.6; P < 0.00001); reduced body weight at 12-14 months (1.6 Kg; 95% CI 0.3 to 3.0; P = 0.02); improved diabetes knowledge at 12-14 months (SMD 1.0; 95% CI 0.7 to 1.2; P < 0.00001) and reduced systolic blood pressure at four to six months (5 mmHg: 95% CI 1 to 10; P = 0.01). There was also a reduced need for diabetes medication (odds ratio 11.8, 95% CI 5.2 to 26.9; P < 0.00001; RD = 0.2; NNT = 5). Therefore, for every five patients attending a group-based education programme we could expect one patient to reduce diabetes medication. AUTHORS' CONCLUSIONS Group-based training for self-management strategies in people with type 2 diabetes is effective by improving fasting blood glucose levels, glycated haemoglobin and diabetes knowledge and reducing systolic blood pressure levels, body weight and the requirement for diabetes medication.
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Affiliation(s)
- T Deakin
- Department of Nutrition & Dietetics, Burnley, Pendle & Rossendlae Primary Care Trust, Burnley General Hospital, Casterton Avenue, Burnley, Lancashire, UK, BB10 2PQ.
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Abstract
BACKGROUND Overweight and obesity are global health problems which are increasing throughout the industrialised world. If left unchecked, they will continue to contribute to the ever increasing noncommunicable disease burden. OBJECTIVES To assess the effects of psychological interventions for overweight or obesity as a means of achieving sustained weight loss. SEARCH STRATEGY Studies were obtained from searches of multiple electronic bibliographic databases. The date of the latest search was June 2003. SELECTION CRITERIA Trials were included if the fulfilled the following criteria: 1) they were randomised controlled clinical trials of a psychological intervention versus a comparison intervention, 2) one of the outcome measures of the study was weight change measured by any method, 3) participants were followed for at least three months, 4) the study participants were adults (18 years or older) who were overweight or obese (BMI > 25 kg/m(2)) at baseline. DATA COLLECTION AND ANALYSIS Two people independently applied the inclusion criteria to the studies identified and assessed study quality. Disagreement was resolved by discussion or by intervention of a third party. Meta-analyses were performed using a fixed effect model. MAIN RESULTS A total of 36 studies met the inclusion criteria and were included in the review. Overall, 3495 participants were evaluated. The majority of studies assessed behavioural and cognitive-behavioural weight reduction strategies. Cognitive therapy, psychotherapy, relaxation therapy and hypnotherapy were assessed in a small number of studies. Behaviour therapy was found to result in significantly greater weight reductions than placebo when assessed as a stand-alone weight loss strategy (WMD -2.5 kg; 95% CI -1.7 to -3.3). When behaviour therapy was combined with a diet / exercise approach and compared with diet / exercise alone, the combined intervention resulted in a greater weight reduction. Studies were heterogeneous however the majority of studies favoured combining behaviour therapy with dietary and exercise interventions to improve weight loss. Increasing the intensity of the behavioural intervention significantly increased the weight reduction (WMD -2.3 kg; 95% CI -1.4 to - 3.3). Cognitive-behaviour therapy, when combined with a diet / exercise intervention, was found to increase weight loss compared with diet / exercise alone (WMD -4.9 kg; 95% CI -7.3 to - 2.4). No data on mortality, morbidity or quality of life were found. AUTHORS' CONCLUSIONS People who are overweight or obese benefit from psychological interventions, particularly behavioural and cognitive-behavioural strategies, to enhance weight reduction. They are predominantly useful when combined with dietary and exercise strategies. The bulk of the evidence supports the use of behavioural and cognitive-behavioural strategies. Other psychological interventions are less rigorously evaluated for their efficacy as weight loss treatments.
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Affiliation(s)
- K Shaw
- Public and Environmental Health Unit, Department of Health and Human Services, Public Health Unit, 3 / 90 Davey Street, Hobart, Tasmania, Australia, 7000.
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Aas AM, Bergstad I, Thorsby PM, Johannesen O, Solberg M, Birkeland KI. An intensified lifestyle intervention programme may be superior to insulin treatment in poorly controlled Type 2 diabetic patients on oral hypoglycaemic agents: results of a feasibility study. Diabet Med 2005; 22:316-22. [PMID: 15717881 DOI: 10.1111/j.1464-5491.2005.01421.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
AIMS The aims of this study were to assess whether, in Type 2 diabetic patients with inadequate glycaemic control on oral hypoglycaemic agents (OHA), a lifestyle intervention programme based on exercise and diet counselling (i) was as effective as insulin treatment in controlling blood glucose, and (ii) could prevent the weight gain usually accompanying the introduction of insulin treatment. METHODS Thirty-eight Type 2 diabetic subjects treated with OHA, HbA(1c) 8-10.5% and body mass index (BMI) 26-40 kg/m2, were randomized to the following treatments: (i) lifestyle intervention (L), (ii) lifestyle intervention + insulin treatment (L+I) and (iii) insulin treatment alone (I). RESULTS There was a reduction in HbA(1c) of -1.2 (interquartile range 1.0), -1.0 (1.7) and -1.5 (2.5)% in group L, L+I and I, respectively, and all treatment groups achieved beneficial changes in blood lipid variables. There was no significant difference between the groups in the change observed in levels of HbA(1c) between start and 12 months of treatment (P = 0.74). There was a significant difference in weight changes between groups (P < 0.01): group L reduced weight by median -3.0 (4.0) kg, groups L+I and I increased weight by 3.5 (3.4) and 4.9 (6.9) kg, respectively. CONCLUSIONS Lifestyle intervention was as effective as insulin treatment in improving glycaemic control in poorly controlled subjects with Type 2 diabetes, and resulted in weight loss during the intervention year. However, glycaemic control deteriorated and body weight increased in the lifestyle intervention group 1 year after the intervention stopped.
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Affiliation(s)
- A M Aas
- Department of Nutrition and Dietetics, Aker University Hospital, Oslo, Norway.
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