Lifestyle intervention program trial: a more successful alternative to medication-only therapy
According to a study of type 2 diabetics, medical telemarketing coupled with a change in eating habits can help them reduce their blood glucose and – a pleasant side-effect – lose weight.
Type 2 diabetics can reduce their blood glucose and weight considerably more with the help of a so-called telemedical lifestyle intervention program than with medication alone. That was the finding of joint trial between the West-German Centre of Diabetes and Health (WGDZ) and the Association of Catholic Clinics Düsseldorf (VKKD). The investigation followed up on the findings of earlier trials, which had shown that lifestyle intervention in the pre-diabetes phase can prevent or slow down the outbreak of the disease. Accordingly, lifestyle intervention during the first stage of the disease can postpone the start of a pharmacological anti-diabetes therapy and reduce the medication dose. Investigations carried out previously say that it is even possible to achieve a cure.
The scientists of the WGDZ and the VKKD wanted to find out if significant positive effects can be produced with such a program for type 2 diabetics in an advanced stage of the disease. Put simply, a lifestyle intervention program means achieving an energetically balanced lifestyle with improved nutritional quality by permanently changing the eating habits and activity behaviour of the participants. The experts regard this as offering the best opportunity for success in the battle against pathological overweight and diabetes because the effect is lasting.
For their trial, the researchers from WGDZ and VKKD developed the Telemedical Lifestyle Intervention Program, or TeLiPro for short. This twelve-week program includes telemonitoring, in other words the examination and monitoring of patients by the doctor carrying out the therapy and a change in the eating habits using a protein-rich meal replacement. Furthermore, TeLiPro includes a structured program of self-monitoring of blood glucose and telemedical coaching using medical-mental motivation techniques. The concrete aim of the trial was to use TeLiPro on type 2 diabetics at an advanced stage of the disease to reduce their blood glucose, body weight and body composition, risk of cardiovascular disease and medication dose. At the same time, the aim was to optimise the quality of life and the eating habits of the participants.
A total of 202 overweight or obese type 2 diabetics aged between 25 and 79 participated in the investigation. Additional criteria for participation were inadequate glycaemic control and a therapy with at least two different anti-diabetes drugs. The test persons were randomised, in other words divided at random into two parallel groups of equal size: the TeLiPro group and the control group. All participants received a self-management guide, a weighing scale, and a step counter. Those in the TeLiPro group also received a blood glucose meter. The devices automatically collected, reported, and transferred the measured data to a personalised online portal so that the participants could monitor the course of their own data. However, the control group only continued to receive their existing routine therapy.
The Almased Vitalkost formula diet from Almased Wellness GmbH was chosen as the dietary intervention for the TeLiPro group. During the first week of the trial, the participants in the TeLiPro group replaced their breakfast, lunch and evening meal with a drink containing one gram of Almased powder per kilogram normal body weight per meal, dissolved in 250 millilitres of water. In addition, they consumed 45 grams of oil rich in omega-3 fatty acids and 750 millilitres of vegetable juice a day. No snacks were allowed.
During weeks 2-4, breakfast and evening meal were replaced by Almased powder, and a low-carbohydrate protein-rich lunch was also allowed. This lunch included 150-200 grams of fish or meat, 500 grams of vegetables, and not more than 50 grams of carbohydrates from whole grain bread or brown rice. During weeks 5-12, only the evening meal was replaced by diet powder.
The participants in the TeLiPro group also received a counselling talk with trained diabetes coaches by phone for about 20-minutes once a week. The phone calls covered information on type 2 diabetes, therapy with anti-diabetes drugs, healthy eating, physical exercise and specific opportunities to change habits. Furthermore, the individual measurements were discussed, and the participants were encouraged to adopt medical-mental motivation techniques and to agree to specific goals.
At the end of the 12-week program, the scientists found a significant improvement in the TeLiPro group in the parameters investigated. In contrast, barely any improvement was registered in the data of the control group. Thus, the average blood glucose of the participants in the TeLiPro group fell from 8.4 to 7.3 per cent, whereas in the control group it only fell from 8.2 to 8.0 per cent. In addition, the TeLiPro participants were able to reduce their average body weight during the twelve-week trial, from 104.3 to 98.1 kilograms. In the control group, however, the average weight only went down from 110.8 to 109.8 kilograms.
According to the trial, the TeLiPro participants were also able to reduce their anti-diabetes medication and their risk of cardiovascular disease significantly. Quality of life and eating habits of the TeLiPro participants also improved. The relatively low drop-out rate of nine per cent for the TeLiPro group was also a clear indication that the test persons had also managed to cope well with the intervention program. To a large extent, the participants in the TeLiPro group also maintained their improvements during the follow-up, which lasted until week 52.
The trial is described in ‘Efficacy of the Telemedical Lifestyle intervention Program TeLiPro in Advanced Stages of Type 2 Diabetes: A Randomized Controlled Trial’ by Dr Kerstin Kempf et al., which was published by the American Diabetes Association in Diabetes Care 2017 Jul; 40(7): 863-871. The complete article can be downloaded at: https://doi.org/10.2337/dc17-0303