Lifestyle Intervention Reduces HbA1C Among African Americans

African Americans with type 2 diabetes experience increased morbidity and mortality. Prior diabetes self-management programs have failed to demonstrate long-term efficacy in this population. This led researchers to evaluate whether an intensive lifestyle intervention for low-income African Americans that would lead to changes in diet and physical activity could help to reduce blood glucose levels.

The study showed that the participants randomized to intensive diabetes self-management, known as Lifestyle Improvement through Food and Exercise (LIFE; n = 106) successfully reduced hemoglobin A1c (HbA1c) after 6 months compared with the participants randomized to receive the standard of care (n =105). However, researchers found no significant differences between the two groups by the end of 12 months, according to study results reported at the ADA’s 76th Scientific Sessions (June 10-14, 2016; New Orleans, LA).

“Sustained behavior change is very difficult and may be especially difficult for low-income, high-risk patients with type 2 diabetes,” said lead investigator Elizabeth B Lynch, PhD, associate professor, Rush University Medical Center, Chicago, IL, in a press statement. “While our results confirm positive results in a high-risk population with intensive educational and social support, they also suggest that, over time, motivated patients take the initiative and achieve glycemic control with standard of care education.”

The study included 211 low-income African American participants (mean age, 55 years) with uncontrolled type 2 diabetes (HbA1c >7%) attending five outpatient clinics in the Cook County Health and Hospitals System (CCHHS) in Chicago. Baseline HbA1c was 9.0±1.7%, body mass index was 35.6±8 kg/m2, duration of diabetes was 11.3±9 years, and 45% were treated with insulin. The majority of participants were female (70%), and 58% had an income of ≤$20,000 per year.

The participants in the LIFE arm were offered 28 group counseling sessions with dietitians and peer supporters in a community setting during the 12-month study period, meeting weekly for the first 4 months; biweekly for the second 4 months; and monthly for the last 4 months. The group sessions involved interactive and culturally-tailored diabetes nutrition education, group exercise sessions, and social support consisting of supportive group discussions and problem-solving assistance. Additionally, the LIFE arm received weekly phone calls from a peer educator. The participants were educated and counseled to be able to self-monitor blood glucose levels and to interpret the levels in order to actively participate in their diabetes management. The control group received 2 group-based diabetes education classes led by a registered dietician in the first 6 months of the study. Although this level of education meets national standards, the researchers noted that it exceeds the usual care for individuals with diabetes in the CCHHS.

At 6 months, participants in the LIFE arm had a significantly greater reduction in HbA1c compared with those in the control arm (−0.76 vs −0.21, respectively; P = .026) as well as a higher percentage who saw a decline of more than 0.5% in their average blood glucose levels (63% vs 42%, respectively; P = .005). These differences, however, were not maintained at 12 months. At the end of the 12-month study period, the control group also exhibited a decrease in HbA1c (−0.63 for the LIFE group vs −0.45 for the control group; P = .47), and an equal number of participants in each group achieved a reduction in HbA1c of more than 0.5% (53% in the LIFE group vs 51% in the control group; P = .89). More participants in the LIFE group achieved glycemic control at 12 months compared with the control group (61% vs 39%, respectively; P = .16), but the difference was not statistically significant, said the researchers.

“One possible explanation for the decrease in HbA1c in the control group is that medication adherence increased in this group, relative to the intervention group,” explained Dr Lynch. “Additional research is needed to identify the most effective strategies to achieve sustained HbA1c control in African Americans with type 2 diabetes.”—Eileen Koutnik-Fotopoulos