Increase in daily steps after a 6-month lifestyle intervention for adults with type 2 diabetes in primary care: a controlled Trial

Abstract

Background: Healthy eating and active living are cornerstones of diabetes management, yet due to a number of systematic factors, patients in primary care settings don’t often receive adequate support for lifestyle change. Our aim was to determine the effectiveness of a certified exercise specialist led behavioral support program for adults with recently diagnosed type 2 diabetes when implemented in primary care.

Methods: Eligible participants from four large non-metro primary care networks in Alberta, Canada were assigned, using a controlled time-series “On-Off” allocation, to either a usual care control group or a pedometer-based walking program led by a certified exercise specialist. The program targeted increased daily walking for the first 3 months followed by a brisk walking speed target and increased substitution of low- relative to high-glycemic index foods over the next 3 months. The primary outcome was physical activity at 6-months, ascertained objectively using pedometers. Secondary outcomes included dietary and relevant clinical markers (e.g, A1c, blood pressure, BMI). We compared outcomes using random effects models, with intent-to-treat analyses.

Results: Of 1000 eligible patients contacted, 198 were enrolled. Of these, 96 were allocated to control and 102 to the intervention. Overall, 50% women, mean age 59.5(SD 8.3) years, A1c 6.8% (SD 1.1), BMI 33.9 kg/m2 (SD 6.8), systolic pressure 125.7 mmHg (SD 16.1), average daily caloric intake 1285.8 (SD 458), average glycemic index 51.1 (4.6), average daily steps 5879 (SD 3130). The control group was older (3.3 years; p=0.005), otherwise no other group differences were observed at baseline. Mean daily pedometer steps increased for the intervention compared to the control at 3-months (1293 [SD 2698] vs. 418 [SD 2458] and 6-months (1481 [SD 2631] vs. 336 [SD 2712]; adjusted p=0.004). No significant differences were observed for diet or clinical outcomes.

Discussion: A 6-month behavioral support program delivered in primary care by a certified exercise specialist can be effective for increasing daily physical activity among adults with recently diagnosed diabetes. Given that the enrolled patients were generally already at recommended clinical targets, the increase in daily steps was not, however, associated with improved metabolic outcomes.