Weight Management as Effective as Medication Intensification for Glycemic Control among Veterans with Type 2 Diabetes
This randomized clinical trial sought to determine whether adding intensive
weight management to group medical visits (WM/GMV) improves glycemia compared with GMV alone, while enhancing weight loss and decreasing medication intensity in patients with uncontrolled type 2 diabetes. Findings showed that for Veterans with diabetes who attended group medical visits, adding intensive
weight management using low-carbohydrate nutrition counseling showed comparable glycemic improvement in addition to other clinical advantages (i.e., reduced weight, medication burden, and hypoglycemic events). The largest differences between the GMV vs. the WM/GMV arms occurred at 16 weeks after the intensive initial phase of the WM/GMV 48-week program. The WM/GMV intervention decreased HbA1c levels by 1.7% from baseline, which was 0.7% lower than the GMV arm. The intervention also led to a 5.6 point difference in diabetes distress symptoms (i.e., stress, depression). The estimated intervention cost per patient was $1,513.42 for patients in the WM/GMV arm, and $1,264.49 for patients in the GMV arm. Thus,
weight management using a low-carbohydrate diet can be as effective for glycemic improvement as medication intensification, with additional benefits (i.e., weight reduction, fewer hypoglycemic events, less medication use); however, strategies are needed to help patients sustain these improvements.
Date: November 4, 2019
- Study Highlights Mental Health Services Important to Women Veterans
Investigators in this study identified a subset of women Veteran primary care users who were potential stakeholders for mental health services, and then quantified their priorities for these services. Treatment for depression, pain management, coping with chronic conditions, sleep problems,
weight management, and PTSD emerged as the top six mental healthcare priorities for women. The majority of women Veterans in this study (98%) selected at least one of these services as important, and 80% selected at least three of these six services as important. The majority of women who prioritized each of these six services reported that they had either used this type of service in the past year or were quite a bit or extremely likely to use the service within the next six months, ranging from 62% for
weight management to 96% for chronic conditions. Findings suggest that women’s primary care clinics, which are available at many VA healthcare facilities, are a strategic setting to enhance the implementation of women’s health services through primary care-mental health integration.
Date: November 17, 2014
- Study Compares VA Weight Loss Interventions for Veterans
The Aspiring for Lifelong Health (ASPIRE) small-changes weight loss intervention was developed to address the need for effective weight loss treatment for vulnerable populations. This randomized clinical trial evaluated the effectiveness of the ASPIRE intervention by randomly assigning obese Veterans to one of three treatment programs: 1) the ASPIRE-Group program, delivered via in-person groups; 2) the ASPIRE-Phone program, delivered to Veterans via phone; or 3) VA’s MOVE! usual care
weight management program, delivered primarily in a group format. Findings showed that all three programs resulted in significant weight loss 12 months afer baseline. Though weight loss was relatively small, ASPIRE-Group resulted in twice the weight loss (-2.8 kg) compared to the other two programs (-1.4 kg each). 20-24% of participants lost 5% of their body weight, with no differences between programs. Both ASPIRE programs (Group and Phone) resulted in more than twice the level of engagement compared to the MOVE! program; ASPIRE-Phone was associated with the greatest engagement. At 12 months, Veterans in all three programs experienced a significant improvement in life satisfaction, HDL, and functional exercise capacity.
Date: September 9, 2014
- Factors Associated with Use of VA MOVE! Program for Obese and Overweight Veterans
This study sought to describe facility-level variability in the utilization of MOVE! (defined as 1 or more visits) – and to examine patient- and facility-level correlates of program use. Findings showed that although substantial variation exists across VA facilities in MOVE! utilization rates (0.05% to 16%), Veterans most in need of obesity management services were more likely to access the
weight management program, although at a low level. Among the 2 million VA patients meeting criteria for obesity in 2010, 4.4% had at least one MOVE! visit. Among Veterans younger than 70, to whom the program is targeted, 6% had at least one visit. Veterans were more likely to have at least one MOVE! visit if they had a higher BMI, were female, unmarried, younger, a minority, or had a psychiatric or obesity-related comorbidity. Veterans at facilities with a higher proportion of Veterans with home instability and lower obeseogenic drug prescription rates were more likely to access MOVE!.
Date: December 10, 2013
Weight Management Program Characteristics Associated with Patient Retention
MOVE! program coordinators identified characteristics associated with patient retention, such as: provider knowledge of and referral to the program, reputation of the program within the medical facility, group meeting schedule (e.g. offering multiple meeting times), inclusion of physical activity in group meetings, and involvement by the MOVE! physician champion. There were no differences in patient retention in regard to the use of introductory sessions, frequency of group meetings, and topics discussed during the meetings. Coordinators at high-retention facilities were more likely to discuss efforts to improve retention. Authors suggest that training for providers is needed to assist with referral decisions, and that program planners should consider incorporating physical activity into group meetings.
Date: July 1, 2012
- VA Care for Obese Veterans
Of those Veterans identified as obese, only 27.7% had an obesity diagnosis in FY02; by 2006, 53.5% had an obesity diagnosis. Although suboptimal, these rates are comparable or better than those recently reported in the public sector. Results also show that an obesity diagnosis, and not BMI per se, was the strongest predictor of receiving obesity-related education. Only about 10-13% of obese Veterans received individual or group outpatient education in nutrition, exercise, or
weight management on an annual basis, and only about one-third received any obesity-related education over the five-year study period. Obese Veterans who were older than 65 years, prescribed fewer types of medications, or lacking an EMR diagnosis of obesity or diabetes were less likely to have outpatient obesity-related education. Investigators also found limited utilization of weight loss medications and bariatric surgery, which may be partially due to system barriers such as access to surgery and medications.
Date: February 24, 2010