Contributions of the counselor in diabetes lifestyle education

Researchers in the Netherlands have reported their findings in the Active Prevention in High-Risk Individuals of Diabetes Type 2 in and Around Eindhoven (APHRODITE) study.

First, the details.

• 925 people at high risk for type 2 diabetes were recruited from several practices and randomly assigned into treatment group.
  • Treatment
    • 11, 20-minute consultations over 2.5 years alternately with the nurse practitioner (main contact) and general practitioner (overseer)
    • 5, 1-hour group meetings were also conducted by dieticians (4) and physical therapists (1).
    • All individuals in the treatment group were invited for a 1-hour personal consultation with the dietitian to discuss a 3-day food record, with suggestions for improvement.
  • Usual-care
• Before starting the project, all nurse practitioners underwent a 5-evening course in motivational interviewing.
• 5 objectives of behavioral change were recorded over 1.5 years.
  • Weight reduction of at least 5% if overweight
  • Physical exercise of moderate or high intensity at least 30 minutes for at least 5 days a week
  • Dietary fat intake less than 30% of total energy intake
  • Saturated fat intake less than 10% of total energy intake
  • Dietary fiber intake of at least 3.4 grams/MJ
• Participant, general practitioner, and nurse practitioner characteristics were compared between individuals who lost weight or maintained a stable weight and individuals who gained weight.

And, the results.

• Both groups showed modest changes in glucose values, weight measures, physical activity, energy intake, and fiber intake.
• Differences were significant only for…
  • Total physical activity
  • Saturated fat intake
  • Fiber intake.
• Differences between general practices were significant for BMI and 2-hour glucose but not for energy intake and physical activity.
• In the treatment group, the nurse practitioners’ average years of work experience was significantly longer in individuals who were successful at losing weight or maintaining a stable weight compared with unsuccessful individuals.
• Furthermore, successful individuals more often had a partner.

The bottom line?

The authors concluded, “Risk factors for type 2 diabetes could be [modestly but] significantly reduced by lifestyle counseling in Dutch primary care.”

“In particular, the level of experience of the nurse practitioner and the availability of partner support seem to facilitate intervention success.” The experience of nurse practitioners was significantly less in the usual-care group (4 years) vs the treatment group (5 years). And, those who were successful in losing weight were more likely to be married or in a stable relationship.

There was no difference in the years of experience among the doctors who oversaw counseling.

Others have reported success with counseling. However, this study differs in that the counseling was more intense, according to the authors.

Caution. Click the link above to read the study and see the statistically significant data outcomes. However, be prepared to ask yourself whether any of these changes resulted in anything approaching clinical significance.

8/6/12 15:01 JR