Article Title



Nathan R. Weeldreyer1, Matthew Martin2, Mindy McEntee2, Farshad Fani Marvasti3, Rodger Kessler4, Glenn Gaesser, FACSM2, Siddhartha S. Angadi, FACSM1. 1University of Virginia, Charlottesville, VA. 2Arizona State University, Phoenix, AZ. 3University of Arizona, Phoenix, AZ. 4University of Colorado Anschutz, Aurora, CO.

BACKGROUND: Type 2 diabetes (T2D) is a common metabolic disorder affecting more than 34 million Americans. The associated hyperglycemia results in substantially increased morbidity and mortality risk. Even though efficacious pharmacotherapies exist, glycemic control remains poor with 33-49% of patients not meeting targets for glycemic control as quantified by HbA1c. This study sought to determine the efficacy of a clinic-based, healthy lifestyle intervention on measures of glycemia and cardiovascular health. METHODS: Patients with T2D (n=20; 56.7±12y; 170±9 cm; 98±22 kg; 33.7±7.2 BMI) with an HbA1c of 7.5-10% not requiring injectable insulin were recruited from the Dignity Health outpatient, family medicine clinic in Phoenix, AZ and underwent a quasi-experimental 3-month lifestyle intervention. Subjects were given a daily à la carte menu of healthy exercise, nutrition, and behavioral options from which to choose from. Exercise options consisted of subjects accumulating 150 minutes of moderate or 75 minutes of vigorous exercise a week utilizing various exercise schemes each day (e.g. 3 x 10 min bouts). The dietary intervention utilized increased fiber and healthy fat intake while avoiding refined and added sugars. This was accomplished by provided healthy food menus, nutritional counseling, and gift cards to local markets. Behavioral interventions utilizing motivational interviewing, acceptance and commitment therapy, and problem-solving therapy were used to help promote behavior change. The intervention was administered to patients by medical assistants in the family medicine clinics. Wilcoxon Signed Rank tests were used to analyze pre-and post-intervention differences. RESULTS: A reduction in HbA1c of 0.5% was observed after the intervention (8.6±0.9 vs. 8.1±1.2% respectively; p= 0.05). Additionally, there was a reduction in waist circumference of 3 cm seen (115.5±12.6 vs. 112.5±15.2 cm; p=0.014). Similarly changes in both body weight (97.7±21.9 vs. 95.6±23.9 kg; p= 0.016) and BMI (33.7±7.2 vs 32.8±7.5 kg/m2; p= 0.028) were observed. CONCLUSIONS: Our pilot data suggest that a lifestyle intervention administered by medical assistants in a family medicine clinic demonstrates improvements in glycemic control, waist circumference, and body mass index. These results remain to be verified in a randomized controlled trial setting. Funding: Dignity Health/Arizona State University Strategic Initiatives Program

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