Willingness to participate in a lifestyle intervention program of patients with type 2 diabetes mellitus: a conjoint analysis

The impact of health vs. non-health goals on individuals' lifestyle program choices: a discrete choice experiment approach

BACKGROUND

Goals play an important role in the choices that individuals make. Yet, there is no clear approach of how to incorporate goals in discrete choice experiments. In this paper, we present such an approach and illustrate it in the context of lifestyle programs. Furthermore, we investigate how non-health vs. health goals affect individuals' choices via non-goal attributes.

METHODS

We used an unlabeled discrete choice experiment about lifestyle programs based on two experimental conditions in which either a non-health goal (i.e., looking better) or a health goal (i.e., increasing life expectancy) was presented to respondents as a fixed attribute level for the goal attribute. Respondents were randomly distributed over the experimental conditions. Eventually, we used data from 407 Dutch adults who reported to be overweight (n = 212 for the non-health goal, and n = 195 for the health goal).

RESULTS

Random parameter logit model estimates show that the type of goal significantly (p < 0.05) moderates the effect that the attribute diet has on lifestyle program choice, but that this is not the case for the attributes exercise per week and expected weight loss.

CONCLUSIONS

A flexible diet is more important for individuals with a non-health goal than for individuals with a health goal. Therefore, we advise policy makers to use information on goal interactions for developing new policies and communication strategies to target population segments that have different goals. Furthermore, we recommend researchers to consider the impact of goals when designing discrete choice experiments.

Using discrete choice experiments to develop and deliver patient-centered psychological interventions: a systematic review

Developing and/or tailoring psychological interventions to align with patient preferences is a critical component of patient-centered care and has the potential to improve patient engagement and treatment outcomes. Discrete choice experiments (DCEs) are a quantitative method of assessing patient preferences that offer numerous strengths (i.e., ability to account for trade-offs), but are not routinely incorporated into health psychology coursework, likely leaving many unaware of the potential benefits of this methodology. To highlight the potential applications of DCEs within health psychology, this systematic review synthesises previous efforts to utilise DCEs to inform the design of patient-centered psychological care, defined as interventions targeting psychological (e.g., depression, anxiety) or behavioural health (e.g., pain management, adherence) concerns. Literature searches were conducted in March 2017 and November 2019 for articles reporting on DCEs using the terms 'discrete choice', 'conjoint', or 'stated preference'. Thirty-nine articles met all inclusion criteria and used DCEs to understand patient preferences regarding psychosocial clinical services (n = 12), lifestyle behaviour change interventions (n = 11), HIV prevention and/or intervention services (n = 10), disease self-management programmes (n = 4), or other interventions (n = 2). Clinical implications as well as limitations and directions for future research are discussed.

Chronically ill patients' preferences for a financial incentive in a lifestyle intervention. Results of a discrete choice experiment

BACKGROUND

The preferences of diabetes type 2 patients and cardiovascular disease patients for a financial incentive added to a specified combined lifestyle intervention were investigated.

METHODS

A discrete choice experiment questionnaire was filled out by 290 diabetes type 2 patients (response rate 29.9%). Panel-mixed-logit models were used to estimate the preferences for a financial incentive. Potential uptake rates of different financial incentives and relative importance scores of the included attributes were estimated. Included attributes and levels were: form of the incentive (cash money and different types of vouchers), value of the incentive (ranging from 15 to 100 euros), moment the incentive is received (start, halfway, after finishing the intervention) and prerequisite for receiving the incentive (registration, attendance or results at group or individual level).

RESULTS

Prerequisites for receiving the financial incentive were the most important attribute, according to the respondents. Potential uptake rates for different financial incentives ranged between 37.9% and 58.8%. The latter uptake rate was associated with a financial incentive consisting of cash money with a value of €100 that is handed out after completing the lifestyle program with the prerequisite that the participant attended at least 75% of the scheduled meetings.

CONCLUSIONS

The potential uptake of the different financial incentives varied between 37.9% and 58.8%. The value of the incentive does not significantly influence the potential uptake. However, the potential uptake and associated potential effect of the financial incentive is influenced by the type of financial incentive. The preferred type of incentive is €100 in cash money, awarded after completing the lifestyle program if the participant attended at least 75% of the scheduled meetings.

A descriptive study of potential participant preferences for the design of an incentivised weight loss programme for people with type 2 diabetes mellitus attending a public hospital in Lima, Peru

Background: Weight loss is important for the control of type 2 diabetes mellitus but is difficult to achieve and sustain. Programmes employing financial incentives have been successful in areas such as smoking cessation. However, the optimum design for an incentivised programme for weight loss is undetermined, and may depend on social, cultural and demographic factors. Methods: An original questionnaire was designed whose items addressed respondent personal and health characteristics, and preferences for a hypothetical incentivised weight loss programme. One hundred people with type 2 diabetes mellitus were recruited to complete the questionnaire from the endocrinology clinic of a public hospital in Lima, Peru. A descriptive analysis of responses was performed. Results: Ninety-five percent of subjects who had previously attempted to lose weight had found this either 'difficult' or 'very difficult'. Eighty-five percent of subjects would participate in an incentivised weight loss programme. Median suggested incentive for 1 kg weight loss every 2 weeks over 9 months was PEN 100 (~USD $30). Cash was preferred by 70% as payment method. Only 56% of subjects would participate in a deposit-contract scheme, and the median suggested deposit amount was PEN 20 (~USD $6). Eighty percent of subjects would share the incentive with a helper, and family members were the most common choice of helper. Conclusions: The challenge of achieving and sustaining weight loss is confirmed in this setting. Direct cash payments of PEN 100 were generally preferred, with substantial scope for involving a co-participant with whom the incentive could be shared. Employing direct financial incentives in future weight loss programmes appears to be widely acceptable among people with type 2 diabetes mellitus.

A descriptive study of potential participant preferences for the design of an incentivised weight loss programme for people with type 2 diabetes mellitus attending a public hospital in Lima, Peru

Background: Weight loss is important for the control of type 2 diabetes mellitus but is difficult to achieve and sustain. Programmes employing financial incentives have been successful in areas such as smoking cessation. However, the optimum design for an incentivised programme for weight loss is undetermined, and may depend on social, cultural and demographic factors. Methods: An original questionnaire was designed whose items addressed respondent personal and health characteristics, and preferences for a hypothetical incentivised weight loss programme. One hundred people with type 2 diabetes mellitus were recruited to complete the questionnaire from the endocrinology clinic of a public hospital in Lima, Peru. A descriptive analysis of responses was performed. Results: Ninety-five percent of subjects who had previously attempted to lose weight had found this either 'difficult' or 'very difficult'. Eighty-five percent of subjects would participate in an incentivised weight loss programme. Median suggested incentive for 1 kg weight loss every 2 weeks over 9 months was PEN 100 (~USD $30). Cash was preferred by 70% as payment method. Only 56% of subjects would participate in a deposit-contract scheme, and the median suggested deposit amount was PEN 20 (~USD $6). Eighty percent of subjects would share the incentive with a helper, and family members were the most common choice of helper. Conclusions: The challenge of achieving and sustaining weight loss is confirmed in this setting. Direct cash payments of PEN 100 were generally preferred, with substantial scope for involving a co-participant with whom the incentive could be shared. Employing direct financial incentives in future weight loss programmes appears to be widely acceptable among people with type 2 diabetes mellitus.

Valuing a Lifestyle Intervention for Middle Eastern Immigrants at Risk of Diabetes

Willingness-to-pay (WTP) techniques are increasingly being used in the healthcare sector for assessing the value of interventions. The objective of this study was to estimate WTP and its predictors in a randomized controlled trial of a lifestyle intervention exclusively targeting Middle Eastern immigrants living in Malmö, Sweden, who are at high risk of type 2 diabetes. We used the contingent valuation method to evaluate WTP. The questionnaire was designed following the payment-scale approach, and administered at the end of the trial, giving an ex-post perspective. We performed logistic regression and linear regression techniques to identify the factors associated with zero WTP value and positive WTP values. The intervention group had significantly higher average WTP than the control group (216 SEK vs. 127 SEK; p = 0.035; 1 U.S.$ = 8.52 SEK, 2015 price year) per month. The regression models demonstrated that being in the intervention group, acculturation, and self-employment were significant factors associated with positive WTP values. Male participants and lower-educated participants had a significantly higher likelihood of zero WTP. In this era of increased migration, our findings can help policy makers to take informed decisions to implement lifestyle interventions for immigrant populations.

Resilience-based Diabetes Self-management Education: Perspectives From African American Participants, Community Leaders, and Healthcare Providers

Purpose The purpose of this qualitative, focus group study was to further refine the Resilience-based Diabetes Self-management Education (RB-DSME) recruitment process and intervention, build greater trust in the community, and identify strategies to enhance its sustainability as a community-based intervention in African American church settings. Methods Six 2-hour focus groups (N = 55; 10 men and 45 women) were led by a trained moderator with a written guide to facilitate discussion. Two sessions were conducted with individuals diagnosed with type 2 diabetes mellitus (T2DM) who participated in previous RB-DSME pilot interventions and their family members, two sessions with local church leaders, and two sessions with community healthcare providers who care for patients with T2DM. Two independent reviewers performed content analysis to identify major themes using a grounded theory approach. The validity of core themes was enhanced by external review and subsequent discussions with two qualitative methods consultants. Results There was expressed interest and acceptability of the RB-DSME program. Church connection and pastor support were noted as key factors in building trust and enhancing recruitment, retention, and sustainability of the program. Core themes across all groups included the value of incentives, the need for foundational knowledge shared with genuine concern, teaching with visuals, dealing with denial, balancing the reality of adverse consequences with hope, the importance of social support, and addressing healthcare delivery barriers. Conclusion Focus groups documented the feasibility and potential effectiveness of RB-DSME interventions to enhance diabetes care in the African American community. In clinical practice, inclusion of these core themes may enhance T2DM self-care and treatment outcomes.

Be Careful What You Ask For: Effects of Benefit Descriptions on Diabetes Patients' Benefit-Risk Tradeoff Preferences

BACKGROUND

As more studies report on patient preferences for diabetes treatment, identifying diabetes outcomes other than glycated hemoglobin (HbA_1c) to describe effectiveness is warranted to understand patient-relevant, benefit-risk tradeoffs.

OBJECTIVE

The aim of the study was to evaluate how preferences differ when effectiveness (glycemic control) is presented as long-term sequela (LTS) risk mitigation rather than an asymptomatic technical marker (HbA_1c).

METHODS

People with type 2 diabetes and using insulin (n = 3160) were randomly assigned to four self-administered, discrete-choice experiments that differed by their presentation of effectiveness. Epidemiologic reviews were conducted to ensure a close approximation of LTS risk relative to HbA_1c levels. The relative importance of treatment benefit-risk characteristics and maximum acceptable risk tradeoffs was estimated using an error-component logit model. Log-likelihood ratio tests were used to compare parameter vectors.

RESULTS

In total, 1031 people responded to the survey. Significantly more severe hypoglycemic events were accepted for a health improvement in terms of LTS mitigation versus HbA_1c improvement (0.7 events per year; 95% confidence interval [CI]: 0.4-1.0 vs. 0.2 events per year 95% CI: -0.02 to 0.5) and avoidance of treatment-related heart attack risk (1.4 severe hypoglycemic events per year; 95% CI: 0.8-1.9 vs. 1 event per year; 95% CI: 0.6-1.3). This finding is supported by a log-likelihood test that rejected at the 0.05 level that respondent preference structures are similar across the different experimental arms of the discrete-choice experiment.

CONCLUSION

We found evidence that benefit descriptions influence elicited preferences for the benefit-risk characteristics of injectable diabetes treatment. These findings argue for using carefully defined effectiveness measures to accurately take account of the patient perspective in benefit-risk assessments.

Statistical Methods for the Analysis of Discrete Choice Experiments: A Report of the ISPOR Conjoint Analysis Good Research Practices Task Force

Conjoint analysis is a stated-preference survey method that can be used to elicit responses that reveal preferences, priorities, and the relative importance of individual features associated with health care interventions or services. Conjoint analysis methods, particularly discrete choice experiments (DCEs), have been increasingly used to quantify preferences of patients, caregivers, physicians, and other stakeholders. Recent consensus-based guidance on good research practices, including two recent task force reports from the International Society for Pharmacoeconomics and Outcomes Research, has aided in improving the quality of conjoint analyses and DCEs in outcomes research. Nevertheless, uncertainty regarding good research practices for the statistical analysis of data from DCEs persists. There are multiple methods for analyzing DCE data. Understanding the characteristics and appropriate use of different analysis methods is critical to conducting a well-designed DCE study. This report will assist researchers in evaluating and selecting among alternative approaches to conducting statistical analysis of DCE data. We first present a simplistic DCE example and a simple method for using the resulting data. We then present a pedagogical example of a DCE and one of the most common approaches to analyzing data from such a question format-conditional logit. We then describe some common alternative methods for analyzing these data and the strengths and weaknesses of each alternative. We present the ESTIMATE checklist, which includes a list of questions to consider when justifying the choice of analysis method, describing the analysis, and interpreting the results.

Measuring Preferences for a Diabetes Pay-for-Performance for Patient (P4P4P) Program using a Discrete Choice Experiment

OBJECTIVE

To elicit a patient's willingness to participate in a diabetes pay-for-performance for patient (P4P4P) program using a discrete choice experiment method.

METHODS

The survey was conducted in March 2013. Our sample was drawn from patients with diabetes at five hospitals in Taiwan (International Classification of Diseases, Ninth Revision, Clinical Modification code 250). The sample size was 838 patients. The discrete choice experiment questionnaire included the attributes monthly cash rewards, exercise time, diet control, and program duration. We estimated a bivariate probit model to derive willingness-to-accept levels after accounting for the characteristics (e.g., severity and comorbidity) of patients with diabetes.

RESULTS

The preferred program was a 3-year program involving 30 minutes of exercise per day and flexible diet control. Offering an incentive of approximately US $67 in cash per month appears to increase the likelihood that patients with diabetes will participate in the preferred P4P4P program by approximately 50%.

CONCLUSIONS

Patients with more disadvantageous characteristics (e.g., elderly, low income, greater comorbidity, and severity) could have less to gain from participating in the program and thus require a higher monetary incentive to compensate for the disutility caused by participating in the program's activities. Our result demonstrates that a modest financial incentive could increase the likelihood of program participation after accounting for the attributes of the P4P4P program and patients' characteristics.

Willingness to participate in prevention programs for cardiometabolic diseases

Background

Cardiometabolic diseases are the leading cause of death worldwide and result in decreased quality of life for patients and increased healthcare costs. Population-based prevention programs may prevent the onset and development of cardiometabolic diseases. The effectiveness of these programs depends on participation rates. This study identified factors related to willingness to participate in health checks and lifestyle intervention programs to prevent cardiometabolic diseases.

Methods

A questionnaire was sent to 1,500 Dutch adults, participating in the Dutch Health Care Consumer Panel of NIVEL. The questionnaire was developed by NIVEL. Predictors of willingness to participate were identified with logistic regression analyses. Predictors investigated were socio-demographic variables, risk factors for cardiometabolic diseases and motivational aspects.

Results

The response rate was 63%. 56% of the participants in our study were willing to participate in a health check. Higher age was associated with increased willingness to participate, as was the desire to know the actual risk for cardiometabolic diseases (OR = 4.6). Becoming unnecessarily worried was identified as a barrier (OR = 0.3). 47% were willing to participate in a lifestyle intervention program. People aged 39–65 were most willing to participate. Attention for prevention relapse behavior (OR = 3.3), informing the general practitioner about results (OR = 2.6) and conducting the program in a group (OR = 2.0) were positively associated with willingness to participate in lifestyle interventions.

Conclusions

Willingness to participate in a health check depended on personal beliefs, whereas social aspects contributed most to willingness to participate in a lifestyle intervention program. This information can be used to optimize and tailor the promotion of prevention programs.

The effect of including an opt-out option in discrete choice experiments

Objective

to determine to what extent the inclusion of an opt-out option in a DCE may have an effect on choice behaviour and therefore might influence the attribute level estimates, the relative importance of the attributes and calculated trade-offs.

Methods

781 Dutch Type 2 Diabetes Mellitus patients completed a questionnaire containing nine choice tasks with an opt-out option and nice forced choice tasks. Mixed-logit models were used to estimate the relative importance of the five lifestyle program related attributes that were included. Willingness to pay (WTP) values were calculated and it was tested whether results differed between respondents who answered the choice tasks with an opt-out option in the first or second part of the questionnaire.

Results

21.4% of the respondents always opted out. Respondents who were given the opt-out option in the first part of the questionnaire as well as lower educated respondents significantly more often opted out. For both the forced and unforced choice model, different attributes showed significant estimates, the relative importance of the attributes was equal. However, due to differences in relative importance weights, the WTP values for the PA schedule differed significantly between both datasets.

Conclusions

Results show differences in opting out based on the location of the opt-out option and respondents' educational level; this resulted in small differences between the forced and unforced choice model. Since respondents seem to learn from answering forced choice tasks, a dual response design might result in higher data quality compared to offering a direct opt-out option. Future research should empirically explore how choice sets should be presented to make them as easy and less complex as possible in order to reduce the proportion of respondents that opts-out due to choice task complexity. Moreover, future research should debrief respondents to examine the reasons for choosing the opt-out alternative.

The patient perspective of diabetes care: a systematic review of stated preference research

BACKGROUND

The importance of understanding the perspective of patients towards their own care is increasingly recognized, both in clinical practice and in pharmaceutical drug development. Stated preference methods to assess the preference of patients towards different aspects of diabetes treatment have now been applied for over a decade.

OBJECTIVE

Our goal was to examine how stated preference methods are applied in diabetes care, and to evaluate the value of this information in developing the patient perspective in clinical and policy decisions.

METHODS

A systematic review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. The information sources were MEDLINE, EMBASE, Biosis, Current Contents, Web of Science, CINAHL, PsycINFO, and EconLit.

RESULTS

Three contingent valuation studies and 11 discrete choice experiments were retrieved. The majority of studies were conducted from 2009 onwards, but some date back to 1998. The reasons provided for applying the stated preference methods were to help differentiate between products, or to enable inclusion of the patient's perspective in treatment decisions. The main aspects of treatment examined were related to glucose control, adverse events, and drug administration. The majority of patients preferred glucose control over avoiding minor hypoglycemic events. Patient willingness to pay was above $US100/month for glucose control, avoiding immediate health hazards such as nausea, and oral or inhaled drug administration. Preference towards drug administration was highly associated with previous experience with injectable diabetes medicine.

CONCLUSIONS

The ability of a drug to lower glucose levels plays a decisive role in the choice between alternative treatments. Future research should strive to develop questionnaire designs relevant for the decision context of the study. That is, if the aim is to foster shared decision making, in clinical practice or drug development, this should guide the study design. Furthermore, concise reporting of all study dimensions-from the qualitative prework to the analysis stage-is warranted.

The development of the Lifestyle and Habits Questionnaire-brief version: relationship to quality of life and stress in college students

The authors describe the development and preliminary evaluation of the Lifestyle and Habits Questionnaire-brief version (LHQ-B). Three hundred seventy-seven undergraduate students (ages 18-25) participated. Responses were collected through either a web-based or face-to-face survey. Data reductive procedures were used with a preexisting lifestyle inventory to create an abbreviated measure. The relationship between lifestyle domains and indicators of wellbeing (levels of stress and quality of life (QOL)) were also examined. Eight lifestyle domains, encompassing 42 items, were identified and found to have good psychometric properties. The resulting LHQ-B measure can be self-administered/scored and contains norm-referenced feedback. The domains of psychological health, physical health and exercise, and sense of purpose were the best predictors of QOL while psychological health, social concern, and the accident prevention domains predicted levels of stress. The results support the use of the LHQ-B in lifestyle research or as a self-administered measure promoting self-awareness of lifestyle behaviors/attitudes in young adults (18-25 years).

The effect of out-of-pocket costs and financial rewards in a discrete choice experiment: an application to lifestyle programs

Background

Both out-of-pocket costs and financial rewards can be used to influence health related behavior. However, it is unclear which of these two has a larger effect on health related behavior. The aim of this study was to explore the possible difference in effect size between out-of-pocket costs and financial rewards on the willingness of diabetes mellitus type 2 (DM2) patients to participate in a lifestyle program.

Methods

A discrete choice experiment (DCE) questionnaire was sent to 767 DM2 patients in a geographically defined area (De Leidsche Rijn, Utrecht) in The Netherlands and completed by 206 of them. The questionnaire comprised of 18 choice tasks of which 9 contained a financial reward for lifestyle program completion, while the other 9 included out-of-pocket costs for program participation. In a second version of the questionnaire, the order of out-of-pocket cost and financial reward choice tasks was counterbalanced to reduce bias with respect to the position (first or second) of the two types of choice tasks. Panel-mixed-multinomial-logit models were used for data analysis.

Results

Increasing out-of-pocket costs were associated with a decreasing willingness to participate in a lifestyle program and, contrary to our expectations, increasing financial rewards were also associated with a decreasing willingness to participate in a lifestyle program. In addition, this willingness to participate changed to the same extent for both increasing out-of-pocket costs and increasing financial rewards.

Conclusions

As expected, increasing out-of-pocket costs may prevent people from deciding to participate in a lifestyle program. However, offering a financial reward to persuade people to participate in a lifestyle program, may result in decreasing willingness to participate in a lifestyle program as well.

Results of a workplace health campaign: what can be achieved?

BACKGROUND

Effective health promotion in the workplace is now essential because of the rising health-related costs for businesses, the increasing pressure arising from international competition, prolonged working lives, and the aging of the work force. The basic problem of prevention campaigns is that the target groups are too rarely reached and sustainable benefits too rarely achieved. In 2011, we carried out a broad-based health and fitness campaign to assess how many personnel could be motivated to participate in a model study under nearly ideal conditions.

METHOD

1010 personnel were given the opportunity to participate in various kinds of sports, undergo sports-medicine examinations, attend monthly expert lectures, and benefit from nutritional offerings and Intranet information during work hours. Pseudonymized questionnaires were used to classify the participants according to their exercise behavior as non-active, not very active, and very active. The participants' subjective responses (regarding, e.g., health, exercise, nutrition, and the factors that motivated them to participate in sports or discouraged them from doing so) were recorded, as were their objective data (measures of body size and strength). The duration of the study was one year.

RESULTS

490 of the 1010 personnel (48.5%, among whom 27.2% were nonactive, 44.1% not very active, and 28.7% very active) participated in the initial questionnaire and testing. By the end of the study, this figure had dropped to 17.8%; diminished participation affected all three groups to a comparable extent. A comparison of dropouts and non-dropouts revealed that older age was a stable predictor for drop-out (bivariate odds ratio [OR] 1.028, p = 0.006; multivariate OR 1.049, p = 0.009). The study participants reported beneficial effects on their health and health awareness, performance ability, psychological balance, stress perception, exercise and dietary behavior.

CONCLUSION

Even under optimal conditions and with high use of staff resources, this model study (which cannot be universally implemented) did not lead to comprehensive and sustained personnel participation. This finding suggests that the currently available prevention instruments are insufficient for the effective and cost-efficient promotion of health and fitness in the workplace.

The effects of an exercise and lifestyle intervention program on cardiovascular, metabolic factors and cognitive performance in middle-aged adults with type II diabetes: a pilot study

BACKGROUND

Canada is experiencing a rise in type II diabetes mellitus (T2DM), a known risk factor for accelerated cognitive decline and dementia. Within the context of an aging population, this will impose significant individual and societal burden, making the development of prevention programs imperative.

OBJECTIVE

This pilot study examines the effects of the Diabetes Exercise and Healthy Lifestyle Service, a 24-week intervention program, on cardiovascular, metabolic regulation and cognitive function in adults with T2DM.

METHODS

Seventeen middle-aged participants provided blood samples for biological markers, underwent cognitive testing and a physical stress test pre- and post-intervention. Cognitive performance was evaluated using the California Verbal Learning Test (CVLT), Digit Symbol Substitution Tasl (DSST) and fluency test.

RESULTS

Adjusted models reveal participants displayed increased cardiovascular fitness (VO2 peak: Mchange=4.09 mL∙kg∙min(-1) SE=1.4), peak heart rate (Mchange= 9.28 beats⋅min(-1) SE=2.68) and change in heart rate (Mchange=10.71 SE=1.76) in response to the stress test (ps<0.05) following the 24-week intervention. A decrease in body mass index (BMI) (Mchange= -1.03 SE=0.40) and depressive symptomatology (CES-D: Mchange = -3.62 SE=1.44) was also found (ps<0.05). No change was found for lipid and glucose levels. Surprisingly, analyses showed that cognitive performance on the CVLT immediate recall (M= -4.37 SE=2.21), CVTL short-delay recall (M= -1.06 SE=0.55), DSST (Mchange= -3 SE=0.53) and category fluency (Mchange= -1.69 SE=0.78) declined following the intervention (ps<0.05); however, decline on the CVLT was limited to adults with co-morbid T2DM and hypertension.

CONCLUSION

Additional research is needed to evaluate the benefit of an exercise and lifestyle program that targets cognitive health in those with T2DM.