Novel Short-Term Weight-Loss Approach Works Long-Term for Type 2 Diabetes
Joslin Diabetes Center Study Offers Alternative for Type 2 Diabetes Management
BOSTON – Sept. 2, 2008 – A study by researchers from the Joslin Diabetes Center has shown for the first time that more than half of patients with type 2 diabetes who enrolled in a novel short-term weight management program were able to maintain the weight loss they achieved during the program on their own long-term.
In addition, participants were able to keep their blood glucose in control on fewer medications and had significant reductions in their total cholesterol, triglycerides, LDL or “bad” cholesterol and C-reactive protein – a measure of inflammation linked to heart attack risk.
The study, published in the August issue of Obesity Management, showed patients with type 2 diabetes enrolled in Joslin’s Weight Achievement and Intensive Treatment program (Why WAIT) lost on average 23.5 pounds or 9.8 percent of their initial body weight during the 12-week program.
At the conclusion of one-year of follow-up, the average weight loss was 18.2 pounds or 7.6 percent of initial body weight. Participants also saw an average of 3.7 inch reductions in waist circumference and a significant reduction in body fat percentage while keeping their lean body mass up.
“Our study shows that the Why WAIT program’s novel combination of diet changes, an exercise plan and medication change, in association with behavioral support and education, works long-term when patients are back on their own in the real world,” said Osama Hamdy, M.D., Ph.D., medical director of the Obesity Clinical Program at Joslin and the study’s lead investigator.
Why WAIT is a 12-week multidisciplinary diabetes weight management program designed for clinical practice. The program, which is mostly covered by insurance, includes a change in diabetes medications to enhance weight reduction by eliminating or reducing medications that can cause weight gain, structured dietary intervention with about 40 percent of daily calories from carbohydrates and 30 percent from protein, high fiber, no trans fats and reduced saturated fats, meal replacement drinks that follow the same dietary composition, an exercise program with an emphasis on strength training, and weekly educational and behavioral support sessions.
“For the last few years, we have been looking for a new target to treat type 2 diabetes,” Hamdy said. “Lowering blood glucose levels alone doesn’t seem to help to prevent the cardiovascular complications associated with type 2 diabetes. This is why we created the Why WAIT weight-management program.”
Reductions in blood pressure, cholesterol levels and inflammation markers indicate that the Why WAIT approach may eventually reduce the risk of cardiac and cerebral events, which are the main causes of death in individuals with diabetes, Hamdy added.
In addition to weight-loss and reductions in cardiovascular risk factors, Why WAIT participants also saw significant decreases in the amounts of diabetes medications they were taking, as well as an associated reduction in medication costs. Patients saved, on average, $561 per year on their diabetes medications alone and the study projected an annual decrease of total health care costs of about $1,619 per patient.
“Many participants were able to stop their diabetes medications altogether,” Hamdy said.
According to the paper, 21 percent of participants on short-acting insulin were able to stop it completely by the end of the program. Remaining patients on insulin therapy were able to reduce their daily dose of long-acting insulin by an average of 55 percent and their daily dose of short-acting insulin dropped by 54 percent. Almost two-thirds of patients on sulfonylureas were able to stop them while remaining participants reduced their doses by between 35 and 41 percent.
“In treating type 2 diabetes, we have been glucose-focused for several decades. It may be the time to switch our efforts to target body weight as the core of the problem,” he said. “The Why WAIT program clearly shows that weight-based diabetes management is a future potential alternative model to glucose-based management. It resulted in a reduction in medication use and cost, and more people were on target for diabetes control with improved quality of life.”
Others clinicians and researchers at Joslin participating in the Why WAIT study were Ann Goebel-Fabbri, Ph.D., Catherine Carver, Gillian Arathuzik, Jacqueline Shahar, Roberta Capelson, Joan Beaton, Stacey O’Donnell, Voula Mentzelopoulos, M.D., and Martin J. Abrahamson, M.D.; and Nuha Elsayed, M.D., of Tufts Medical School and Joanna Mitri, M.D., of Roger Williams Medical Center, Providence, R.I.