Weight Loss Intervention May Improve Type 2 Diabetes Management

A web-based weight loss intervention in the United Kingdom resulted in some positive indications, including reduced waist measurements and a reduction in body mass index (BMI), possibly offering a potential avenue for obesity management in patients with type 2 diabetes (T2D).

This pilot, parallel 2-arm, individually randomized controlled trial with embedded process evaluation was conducted by Anna Haste, PhD, of the Institute of Health and Society at Newcastle University in Newcastle upon Tyne in the United Kingdom, and colleagues.

Although this trial was conducted in the United Kingdom, with cost to the National Health Service (NHS) in mind, obesity among those with diabetes is an issue throughout the world, and certainly in the United States. In the current trial, men with T2D were the focus.

The authors explain, “Recruiting men to weight loss programs is notoriously difficult,” adding that men in the United Kingdom have historically been drawn to “programs that did not require extensive face-to-face time commitments, suggesting the potential for men to favor or at least be accepting of web-based interventions.”

A previous study showed that an individualized, web-based program was successful in reducing glycated hemoglobin and 2-hour postprandial blood glucose tests in patients who were obese and diagnosed with T2D.

This pilot trial was multicentered and the participants were men with T2D who had a BMI of at least 30 kg/m², but less than 40kg/m². The researchers followed the existing guidelines for weight management services used within the NHS.

“The primary outcomes were recruitment and retention in the trial,” say the researchers, “as measured by rates of eligibility, response to invitation, ineligibility, declines, consent, and retention for data collection at 3 and 12 months.”

Seven general practices searched their databases and 968 men who fit the inclusion criteria were identified. Of those, 85 were interested in joining the study, but 5 of those were found to be ineligible due to changes in BMI. A significant portion, 19.3%, explicitly declined the invitation to participate, and 61.5% of them did not give a reason.

Lack of web access, work commitments, poor health, and age were given as reasons by those who chose to provide a reason for declining. The authors wrote, “The vast majority of invited participants did not respond to the letter (696/968, 71.9%).”

Both data completion and retention rates dropped as the study progressed. In the control group, 43% quit by the 3-month mark, and of the remaining 28 participants, 16 (57%) dropped out by the end of the study. In the intervention group, attrition rates were slightly better, with 27% quitting by 3 months and 39% by 12 months. In both groups, the participants who quit cited being too busy, and having work and/or family commitments.

The researchers analyzed data from 19 men, and found that the diet-related portions of the website were used more than the exercise sections. “Participants did not use the social support features, interactive chat room, and discussion forums at all,” they reported. There were 13 semistructured interviews with participants, and several themes were identified, including practicality, interaction with the healthcare professional, and future development of web-based interventions.

The authors reported achieving the original recruitment target of 60 men, but also identified some areas for improvement. For example, healthcare professionals were not required to report reasons for missed consultations, and the researchers suggested that may have been helpful. Additionally, a face-to-face meeting could have provided an opportunity to introduce the web site and all of its functions and resources.

“This research provides preliminary findings that recruitment of men with type 2 diabetes is possible within a web-based intervention,” the researchers said in their conclusion. They suggested that changes to the website could improve adherence and retention.

The full study can be found in the journal JMIR Diabetes.