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It is one thing to find a strategy that works in the lab, but quite another to prove it is effective in the real world as well.
ThereA decade of the National Institutes of Health researchers made headlines when they published the results of the Diabetes Prevention Program (DPP). The study, which was designed to compare the effects of diet and exercise against the best drugs against chronic disease, surprisingly showed that diet and exercise were better than the best drugs scientists have developed to protect those most at risk of developing diabetes.
The results are encouraging and discouraging at the time, however, since lifestyle changes are notoriously the most difficult to implement. It is too difficult for patients stick with a diet and exercise program, and even if they did, their motivation is usually weakens after six months.
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But the conclusions -The diet and exercise group reduced their risk diabetes get 58% from those drugs -were too amazing to ignore. The DPP was based on an intensive and highly individualized to help patients stay on their diet and fitness regimes. How strategies used in the DPP could be modified to work in the real world, where personal nutritionists and trainers are not always at our disposal?
Dr. Jun Ma, an investigator associated with the Palo Alto Medical Institute Research Foundation and consulting professor at Stanford University, was eager to find out. As a primary care doctor, she said, "we know there are many patients out there who need this type of intervention. We just do not have the manpower and resources to provide interventions such as the one tested in the DPP. It motivated me and my staff to find practical ways to provide the principles of the DPP for a more realistic manner "
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Ma joined forces with the University of Pittsburgh scientists who had participated in the DPP government and were already addressing this issue very. The 12-week program involved weekly sessions either face-to-face with a dietitian and fitness instructor in a classroom setting in which participants learned and discussed the diet and exercise techniques that are healthy, or a self-motivation program based DVD that taught participants with similar healthy living techniques. I used the same group and Lifestyle Balance program DVD in his study of 241 people with pre-diabetes, but changed that the group of self-motivated received in adding online and email advice.
After three months of intensive training and a year of maintenance sessions, the group led by coaches lost an average of 14 pounds, while the DVD group shed 10 pounds; the control group, who received standard care but no specific target weight loss, lost only five pounds. More than double the proportion of people who use coach-led sessions (37%) met the target DPP lost 7% of their body weight departure, while 36% of those using DVDs and only 14% of those receiving usual care have achieved this.
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The results confirm that the new strategies to help those at risk to control and even reverse the impending symptoms can be just as effective, if not more in some cases, the treatments currently available. "I would encourage national initiatives to consider other ways to lower the risk of diabetes, such as those we tested," said Ma. "Based on the evidence, interventions face-to-face seem have the strongest effect, but there are data to support the accumulation of alternative delivery strategies such as DVD or online. And given the number of people at risk for diabetes and heart disease, we need to find effective and sustainable ways to reach these people. "
Ma said she and her colleagues deliberately tested strategies such as the use of e-mail reminders, online tips and DVD self-initiated sessions because they rely on resources already existing and would not require significant investments in infrastructure. Although the study only followed participants for 15 months, Ma said further research on these alternative strategies may lead to methods that are more sustainable and still inspire greater compliance in the future. "in the longer term monitoring and the long-term success is something that attracts a lot of research interest at the moment," she said. And as the results suggest, for good reason.
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