Group visits combined with weight loss counseling improve diabetes outcomes

For people with difficult-to-control diabetes, adding intensive weight management counseling to group medical visits provided extra health benefits beyond improved blood-sugar control, according to a new study led by researchers at the Duke Diet and Fitness Center and the U.S. Department of Veterans Affairs (VA), and published in JAMA Internal Medicine.

The weight counseling approach emphasized a low-carb diet, with participants logging better weight loss, less use of diabetes medications, and fewer potentially dangerous episodes of plummeting blood sugar levels compared to study participants who only attended group diabetes sessions.

Researchers enrolled 263 people with uncontrolled diabetes and followed them over the one-year study. Half of the participants were randomly assigned to participate in group medical visits monthly for four months to learn how to manage their diabetes. The other half were assigned to group medical visits that included intensive diet coaching aimed at keeping them on a low-carbohydrate regimen. This group met every two weeks for four months.

After the first four months, both groups met every eight weeks until the study ended. Initially, participants who had the diet intervention showed marked improvement in blood glucose control compared to those in the other group, but by the end of the study, those differences evened out and both interventions proved similarly helpful in lowering glucose levels.

However, the addition of weight management counseling provided extra health benefits, including weight loss and a 50 percent reduction in incidents of hypoglycemia. What's more, diabetes medication use declined for participants in the weight management group while it rose in the other group.

"Intensive weight management using a low-carbohydrate diet can be as effective for glycemic improvement as medication intensification," said William Yancy, MD, director of the Duke Diet and Fitness Center and research associate at the Durham VA Medical Center. "We know that lifestyle changes can be difficult to maintain, but this study shows that group meetings can be an efficient and effective strategy that helps patients sustain these improvements."