In type 2 diabetes, a primary care–led weight management program increased weight loss and diabetes remission at 2 years

2019 ◽  
Vol 171 (4) ◽  
pp. JC17
Author(s):  
Anupam Goel
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Weight Loss ◽  
Weight Management ◽  
Diabetes Remission ◽  
Management Program ◽  
Weight Management Program

scholarly journals Long-Term Weight-Loss Maintenance by a Meal Replacement Based Weight Management Program in Primary Care

Obesity Facts ◽  
2017 ◽  
Vol 10 (2) ◽  
pp. 76-84 ◽  
Author(s):  
Renate Kruschitz ◽  
Sandra Wallner-Liebmann ◽  
Harald Lothaller ◽  
Maria Luger ◽  
Bernhard Ludvik
Keyword(s):  
Primary Care ◽  
Weight Loss ◽  
Weight Management ◽  
Weight Loss Maintenance ◽  
Management Program ◽  
Weight Management Program ◽  
Meal Replacement

Medication Associated with Weight Gain May Influence Outcome in a Weight Management Program

2005 ◽  
Vol 39 (7-8) ◽  
pp. 1204-1208 ◽  
Author(s):  
Margaret Malone ◽  
Sharon A Alger-Mayer ◽  
Drew A Anderson
Keyword(s):  
Weight Loss ◽  
Weight Gain ◽  
Weight Management ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Median Number ◽  
Management Program ◽  
Weight Management Program ◽  
Frequency Of Use ◽  
The Mean

BACKGROUND Weight gain is a commonly overlooked adverse effect of some medications that potentially confounds weight loss efforts in individuals who are overweight and obese. OBJECTIVE To determine the frequency of use of drugs associated with weight gain by participants and the effect on outcome in a weight management program. METHODS Adult patients >18 years of age were recruited from an outpatient, university-based setting to participate in a 20-week structured weight management program. RESULTS Ninety patients (74 women) were recruited (mean [± SD] age 48 ± 10 y, mean body mass index 37 ± 6 kg/m 2 ). Patients had multiple diseases including type 2 diabetes mellitus (n = 23), hypertension (n = 48), depression (n = 18), and dyslipidemia (n = 9). The median number of drugs per patient was 4.0 (range 0–15). The median number of drugs associated with weight gain was zero (range 0–3). Forty-three (48%) patients were taking at least one of these agents, including β-blockers (n = 18), selective serotonin-reuptake inhibitors (n = 18), sulfonylureas (n = 7), insulin (n = 9), and thiazolidinediones (n = 6). Seven patients completed ≤6 weeks of the program and were excluded from further analysis, and 83 patients completed 10 weeks. Of these 83 patients, 39 had lost ≤2% of their initial weight; 23 (59%) of those 39 were taking drugs associated with weight gain. Fifty-nine patients completed the full 20 weeks. The mean overall weight loss of completers was 4.8 ± 5.0% (range −5.9 [gain] to 17.1% [loss]) at 20 weeks. CONCLUSIONS Patients taking WGDs weighed more at baseline and were less likely to lose weight in this program. Attention should be given when prescribing such medications to obese patients, as this may negatively influence their weight management.

OP272 Two-Year Within-Trial And Estimated Lifetime Cost Effectiveness Of The Weight Management Program In The Diabetes REmission Clinical Trial (DiRECT)

2020 ◽  
Vol 36 (S1) ◽  
pp. 4-4
Author(s):  
Yiqiao Xin ◽  
Andrew Davies ◽  
Andrew Briggs ◽  
Louise McCombie ◽  
C. Martina Messow ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Clinical Trial ◽  
Cost Effectiveness ◽  
Cost Saving ◽  
Lifetime Cost ◽  
Diabetes Remission ◽  
Management Program ◽  
Weight Management Program ◽  
Trial Cost

IntroductionType 2 diabetes results mainly from weight gain in adult life and affects one in twelve people worldwide. In the Diabetes REmission Clinical Trial (DiRECT), the primary care-led Counterweight-Plus weight management program achieved remission of type 2 diabetes (for up to six years) for forty-six percent of patients after one year and thirty-six percent after two years. The objective of this study was to estimate the implementation costs of the program, as well as its two-year within-trial cost effectiveness and lifetime cost effectiveness.MethodsWithin-trial cost effectiveness included the Counterweight-Plus costs (including training, practitioner appointments, and low-energy diet), medications, and all routine healthcare contacts, combined with achieved remission rates. Lifetime cost per quality-adjusted life-year (QALY) was estimated according to projected durations of remissions, assuming continued relapse rates as seen in year two of DiRECT and the consequent life expectancy, quality of life and healthcare costs.ResultsThe two-year intervention cost was EUR 1,580 per participant, with over eighty percent of the costs incurred in year one. Compared with the control group, medication savings were EUR 259 (95% confidence interval [CI]: 166–352) for anti-diabetes drugs and EUR 29 (95% CI: 12–47) for anti-hypertensive medications. The intervention was modeled with a lifetime horizon to achieve a mean 0.06 (95% CI: 0.04–0.09) gain in QALYs for the DiRECT population and a mean total lifetime cost saving per participant of EUR 1,497 (95% CI: 755–2,331), with the intervention becoming cost-saving within six years.ConclusionsThe intensive weight loss and maintenance program reduced the cost of anti-diabetes drugs through improved metabolic control, achieved diabetes remission in over one-third of participants, and reduced total healthcare contacts and costs over two years. A substantial lifetime healthcare cost saving is anticipated from periods of diabetes remission and delaying complications. Healthcare resources could be shifted cost effectively to establish diabetes remission services, using the existing DiRECT intervention, even if remissions are only maintained for limited durations. However, more research investment is needed to further improve weight-loss maintenance and extend remissions.

scholarly journals Sustainability of weight loss from a family-centered pediatric weight management program integrated in primary care

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Veronica Else ◽  
Qiaoling Chen ◽  
Alan B. Cortez ◽  
Corinna Koebnick
Keyword(s):  
Primary Care ◽  
Weight Loss ◽  
Weight Management ◽  
Management Program ◽  
Lifestyle Changes ◽  
Relative Distance ◽  
Current Evidence ◽  
Weight Management Program ◽  
Significant Difference ◽  
Pediatric Weight Management

Abstract Background A 6-month pediatric weight loss program showed modest success, but the sustainability of this success after 12 months was unclear. The present study aims tomeasure the medium-term effectiveness of family-based weight management in pediatric primary care to reduce body weight in children living with obesity. Methods In a retrospective cohort study, children ages 3 to 17 years with obesity in Kaiser Permanente Orange County, California, who enrolled in a weight management program between April 2014 and December 2018 (FB-WMG, n = 341) were compared to children referred but not enrolled (Ref-CG, n = 317) and controls matched by sex, age, zip code and BMI (Area-CG, n = 801). The relative distance from the median BMI-for-age at months 0, 6, and 12 were expressed as difference-in-differences (DID) using multivariable linear regressions with robust standard error. Results The baseline BMI-for-age was 98.6 (SD 1.08) percentile in FB-WMG, 98.2 (SD 1.22) percentile in Ref-CG, and 98.6 (1.13 in Area-CG). FB-WMG had a median of 3 visits (P25 1 visit, P75 5 visits) in the first 6 months. Despite a more considerable decrease in the relative distance to the median BMI-for-age in FB-WMG children with 3+ visits after 6 months, the success obtained was not sustained at 12 months (DID FB-WMG vs Area-CG -0.34, 95% CI − 3.00 to 2.33%, FB-WMG vs Ref-CG -0.39, 95% CI − 3.14 to 2.35%). At 12 months, there was no statistical significant difference between the three groups (FB-WWG, Ref-CG, Area-CG). Conclusions The initial success in weight management was not sustained in the absence of continued support for healthy lifestyle changes. Based on current evidence, continued support is necessary to maintain and promote success beyond a brief 6 month intervention. Long-term pediatric weight management programs are needed to promote continuing progress.

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