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. 2017 Sep;31(9):1430-1436.
doi: 10.1016/j.jdiacomp.2017.06.001. Epub 2017 Jun 6.

Participation in a National Lifestyle Change Program is associated with improved diabetes Control outcomes

Sandra L Jackson  1 , Lisa R Staimez  2 , Sandra Safo  3 , Qi Long  3 , Mary K Rhee  4 , Solveig A Cunningham  2 , Darin E Olson  4 , Anne M Tomolo  5 , Usha Ramakrishnan  2 , Venkat K M Narayan  2 , Lawrence S Phillips  4
Affiliations

Participation in a National Lifestyle Change Program is associated with improved diabetes Control outcomes

Sandra L Jackson et al. J Diabetes Complications. 2017 Sep.

Abstract

Aims: Clinical trials show lifestyle change programs are beneficial, yet large-scale, successful translation of these programs is scarce. We investigated the association between participation in the largest U.S. lifestyle change program, MOVE!, and diabetes control outcomes.

Methods: This longitudinal, retrospective cohort study used Veterans Health Administration databases of patients with diabetes who participated in MOVE! between 2005 and 2012, or met eligibility criteria (BMI ≥25kg/m2) but did not participate. Main outcomes were diabetic eye disease, renal disease, and medication intensification.

Results: There were 400,170 eligible patients with diabetes, including 87,366 (22%) MOVE!

Participants: Included patients were 96% male, 77% white, with mean age 58years and BMI 34kg/m2. Controlling for baseline measurements and age, race, sex, BMI, and antidiabetes medications, MOVE! participants had lower body weight (-0.6kg), random plasma glucose (-2.8mg/dL), and HbA1c (-0.1%) at 12months compared to nonparticipants (each p<0.001). In multivariable Cox models, MOVE! participants had lower incidence of eye disease (hazard ratio 0.80, 95% CI 0.75-0.84) and renal disease (HR 0.89, 95% CI 0.86-0.92) and reduced medication intensification (HR 0.82, 95% CI 0.80-0.84).

Conclusions: If able to overcome participation challenges, lifestyle change programs in U.S. health systems may improve health among the growing patient population with diabetes.

Keywords: Diabetes complications; Diabetes mellitus; Veterans; Weight loss; Weight reduction programs.

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Conflict of interest statement

Conflictions of Interest

The authors declare that there is no duality of interest associated with this manuscript. With regard to potential conflicts of interest, within the past several years, Dr. Phillips has served on Scientific Advisory Boards for Boehringer Ingelheim and Janssen, and has or had research support from Merck, Amylin, Eli Lilly, Novo Nordisk, Sanofi, PhaseBio, Roche, Glaxo SmithKline, and the Cystic Fibrosis Foundation. In the past, he was a speaker for Novartis and Merck, but not for the last several years. Qi Long receives support from Cystic Fibrosis Foundation and American Heart Association and was a consultant for Eisai. Sandra Jackson previously received support from Amylin, and Venkat Narayan receives support from Novo Nordisk. These activities involve diabetes, but have nothing to do with this manuscript. Other authors have no potential conflicts of interest to declare.

Figures

Figure 1
Figure 1. Study Population, 2005–2012
Weight-related health conditions included diabetes, hypertension, dyslipidemia, sleep apnea, or osteoarthritis. Excluded health conditions, consistent with a prior study of MOVE, included diagnoses of sepsis, pregnancy, cancer other than skin cancer, neurodegenerative disease, HIV, or anorexia, or receipt of hospice or nursing home care.
Figure 2
Figure 2. Association between MOVE! Participation and Incidence of Diabetes Complications and Medication Intensification in U.S. Veterans, by Subgroup, 2005–2012
Cox proportional hazards models included all covariates in Table 3. Wald p-values for interaction terms are shown, for subgroups: sex, race, age category (years), BMI category (kg/m2), duration of diabetes at baseline (years), and diabetes medication status at baseline. Hazard ratios less than 1 (to the left of the dashed axis) indicate that MOVE! participation was associated with reduced incidence of diabetes complications. Significant p-values indicate possible heterogeneity of effects across subgroups.
Figure 2
Figure 2. Association between MOVE! Participation and Incidence of Diabetes Complications and Medication Intensification in U.S. Veterans, by Subgroup, 2005–2012
Cox proportional hazards models included all covariates in Table 3. Wald p-values for interaction terms are shown, for subgroups: sex, race, age category (years), BMI category (kg/m2), duration of diabetes at baseline (years), and diabetes medication status at baseline. Hazard ratios less than 1 (to the left of the dashed axis) indicate that MOVE! participation was associated with reduced incidence of diabetes complications. Significant p-values indicate possible heterogeneity of effects across subgroups.
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