Effectiveness of the Diabetes Prevention Program for Obesity Treatment in Real World Clinical Practice in a Middle-Income Country in Latin America
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Participating Clinics
2.3. Training for Health Providers
2.4. Recruitment
2.5. Inclusion Criteria
2.6. Study Intervention
2.7. Behavior Change Protocol
2.8. Individual Consultations for Nutrition Counseling
2.9. Study Measures
2.10. Statistical Analysis
3. Results
3.1. Participants, Baseline Characteristics, and Attendance at Scheduled Visits
3.2. Change in Primary Outcome at 6 Months
Changes in Secondary Variables at 6 Months
3.3. Follow-Up of Participants at 12 Months
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Hours | Topics |
---|---|
3.5 months (weekly) | Session 1. Welcome to the Lifestyle Balance Program® Session 2. Be a fat and calorie detective Session 2.1 Reading a nutrition label Session 2.2 Cooking demonstration and food weighing * Session 3. Move those muscles Session 4. Food groups and portion sizes * Session 5. Healthy eating and calorie balance tilting Session 6. Take control of what’s around you Session 7. How to design your own menu (Mexican System for Food Equivalents) * Session 8. Problem solving Session 9. Four key points to eating out healthily and the slippery slope of lifestyle change Session 10. Make social cues work for you and activity plan kickoff Session 11. You can manage stress Session 12. How to feel motivated |
3.5–6 months (biweekly) | Session 13. Obesity risks * Session 14. Diabetes prevention * Session 15.1 Heart health and cholesterol * Session 15.2 Heart health and hypertension * Session 16. Relationship between obesity and cancer * |
6–12 months (monthly) | Session 17. Getting ready for long-term self-control and adjust your thoughts for long-term self-control Session 18. More volume, less calories and conscious eating Session 19. Strengthen your exercise program Session 20. Stretching: the truth about flexibility Session 21. Rise for your health Session 22. Looking at the past and looking at the future |
Variable | Clinic 1 n = 35 | Clinic 2 n = 25 | Clinic 3 n = 21 | Clinic 4 n = 25 | Clinic 5 n = 27 |
---|---|---|---|---|---|
Female, n (%) | 26 (74.2) | 18 (72.0) | 18 (85.7) | 20 (80.0) | 24 (88.9) |
Age, mean ± SD, year | 43.5 ± 11.7 | 44.8 ± 9.84 | 48.1 ± 8.05 | 47.2 ± 8.10 | 46.4 ± 9.94 |
Education, n (%) | |||||
Elementary school | 2 (5.71) | 10 (40.0) | 4 (19.1) | 5 (20.0) | 3 (11.1) |
High school | 15 (42.9) | 7 (28.0) | 7 (33.3) | 8 (32.0) | 7 (25.9) |
College/University | 14 (40.0) | 6 (24.0) | 9 (42.9) | 9 (36.0) | 15 (55.6) |
Postgraduate | 4 (11.4) | 2 (8.00) | 1 (4.76) | 3 (12.0) | 2 (7.41) |
Monthly income, n (%) a | |||||
<U.S. $296 | 11 (31.4) | 8 (32.0) | 1 (4.76) | 7 (28.0) | 3 (11.1) |
U.S. $296 to $592 | 4 (11.4) | 6 (24.0) | 6 (28.6) | 9 (36.0) | 11 (40.7) |
U.S. $592 to $1,185 | 11 (31.4) | 4 (16.0) | 12 (57.1) | 7 (28.0) | 7 (25.9) |
U.S. $1,185 to $1,777 | 6 (17.1) | 4 (16.0) | 1 (4.76) | 0 (0.00) | 1 (3.70) |
≥U.S. $1,777 | 3 (8.57) | 3 (12.0) | 1 (4.76) | 2 (8.00) | 5 (18.5) |
Marital status, n (%) | |||||
Single | 10 (28.6) | 4 (16.0) | 2 (9.52) | 5 (20.0) | 9 (33.3) |
Married | 21 (60.0) | 19 (76.0) | 17 (81.0) | 16 (64.0) | 16 (59.3) |
Divorced | 3 (8.57) | 2 (8.00) | 2 (9.52) | 4 (16.0) | 0 (0.00) |
Widowed | 1 (2.86) | 0 (0.00) | 0 (0.00) | 0 (0.00) | 2 (7.41) |
Diseases by self-report, n (%) | |||||
Type 2 diabetes | 2 (5.71) | 5 (20.0) | 5 (23.8) | 4 (16.0) | 4 (14.8) |
Hypertension | 6 (17.1) | 6 (24.0) | 8 (38.1) | 6 (24.0) | 6 (22.2) |
Abnormal lipids | 2 (5.71) | 3 (12.0) | 0 (0.00) | 2 (8.00) | 1 (3.70) |
Hypothyroidism | 4 (11.4) 3 | 1 (4.00) 3 | 7 (33.3) 1,2,4 | 1 (4.00) 3 | 5 (18.5) |
Depression | 1 (2.86) | 2 (8.00) | 2 (9.52) | 1 (4.00) | 0 (0.00) |
Hypoglycemic drugs, n (%) b | 1 (2.86) | 5 (20.0) | 5 (23.8) | 4 (16.0) | 4 (14.8) |
Height, mean ± SD, m | 1.63 ± 0.08 | 1.63 ± 0.07 | 1.60 ± 0.07 | 1.63 ± 0.07 | 1.61 ± 0.07 |
Weight, mean ± SD, kg | 92.6 ± 19.6 | 91.7 ± 11.8 | 86.8 ± 13.2 | 94.7 ± 21.2 | 85.8 ± 13.0 |
Body mass index, mean ± SD, kg/m2 | 34.7 ± 5.20 | 34.6 ± 3.98 | 34.2 ± 6.11 | 35.4 ± 6.54 | 33.2 ± 5.17 |
Waist circumference, mean ± SD, cm | 107 ± 13.0 | 109 ± 10.6 | 105 ± 12.4 | 110 ± 16.5 | 103 ± 10.5 |
Body fat percentage, mean ± SD c | 44.6 ± 5.42 | 44.7 ± 5.78 | 45.2 ± 5.57 | 44.8 ± 5.32 | 45.3 ± 6.24 |
Systolic blood pressure, mean ± SD, mmHg | 122 ± 12.3 | 119 ± 11.8 | 130 ± 18.3 | 125 ± 16.6 | 119 ± 11.1 |
Diastolic blood pressure, mean ± SD, mmHg | 77.3 ± 6.81 | 74.8 ± 9.98 | 78.0 ± 12.2 | 75.8 ± 11.7 | 75.7 ± 7.75 |
Fasting glucose, mean ± SD, mg/dL | 86.3 ± 32.2 | 97.9 ± 42.6 | 86.4 ± 15.4 | 91.2 ± 24.9 | 84.7 ± 26.2 |
Fasting insulin, median (P25, P75), µU/mL c | 6.63 (5.11, 11.8) | 6.06 (4.39, 11.9) | 6.07 (4.49, 8.60) | 5.27 (3.24, 8.17) | 4.93 (4.06, 8.46) |
HOMA-IR, median (P25, P75) d | 1.31 (1.01, 2.39) | 1.21 (0.81, 2.97) | 1.15 (0.86, 2.37) | 1.06 (0.60, 1.86) | 0.95 (0.71, 1.91) |
Triglycerides, mean ± SD, mg/dL | 138 ± 81.9 | 161 ± 71.6 | 177 ± 156 | 164 ± 68.4 | 135 ± 74.6 |
Total cholesterol, mean ± SD, mg/dL | 169 ± 27.5 4 | 194 ± 50.2 | 181 ± 57.4 | 197 ± 34.0 1 | 190 ± 46.9 |
High-density lipoprotein-cholesterol (HDL-cholesterol), mean ± SD, mg/dL | 53.0 ± 10.5 3 | 50.6 ± 17.4 | 42.2 ± 12.9 1 | 45.9 ± 11.3 | 43.6 ± 11.8 |
Low-density lipoprotein-cholesterol (LDL-cholesterol), mean ± SD, mg/dL | 89.3 ± 28.1 4,5 | 111 ± 44.3 | 103 ± 36.5 | 119 ± 31.5 1 | 119 ± 45.7 1 |
Aspartate aminotransferase, mean ± SD, U/L | 14.9 ± 5.78 | 16.3 ± 3.39 | 18.9 ± 6.98 | 18.2 ± 8.57 | 20.6 ± 9.99 d |
Alanine aminotransferase, mean ± SD, U/L | 14.7 ± 4.20 5 | 17.1 ± 4.54 | 15.6 ± 4.64 | 17.8 ± 6.54 | 19.9 ± 7.58 1 |
Metabolic syndrome, n (%) e | 12 (34.3) | 15 (60.0) | 13 (61.9) | 15 (60.0) | 10 (37.0) |
Metabolically healthy, n (%) f | 23 (65.8) | 10 (40.0) | 8 (38.1) | 10 (40.0) | 16 (59.3) |
Metabolically unhealthy, n (%) g | 12 (34.3) | 15 (60.0) | 13 (61.9) | 15 (60.0) | 11 (40.7) |
Variable | Baseline Mean ± SD | 6 Months Mean ± SD | Difference to 6 Months Mean ± SD | pa Value | pb Value |
---|---|---|---|---|---|
BMI (kg/m2) | <0.001 | ||||
Clinic 1 | 34.7 ± 5.20 | 31.8 ± 5.34 | −2.97 ± 2.65 2,3,5 | <0.0001 | |
Clinic 2 | 34.6 ± 3.98 | 33.4 ± 4.26 | −1.28 ± 1.51 1 | <0.001 | |
Clinic 3 | 34.2 ± 6.12 | 33.1 ± 6.11 | −1.07 ± 1.87 1 | 0.015 | |
Clinic 4 | 35.4 ± 6.54 | 33.5 ± 6.02 | −1.90 ± 1.89 | <0.0001 | |
Clinic 5 | 33.2 ± 5.17 | 32.0 ± 4.96 | −1.26 ± 1.55 1 | <0.001 | |
Waist circumference (cm) | 0.023 | ||||
Clinic 1 | 107 ± 13.0 | 98.0 ± 13.3 | −9.44 ± 6.86 3 | <0.0001 | |
Clinic 2 | 109 ± 10.6 | 103 ± 9.40 | −5.81 ± 5.86 | <0.0001 | |
Clinic 3 | 105 ± 12.4 | 101 ± 11.7 | −3.76 ± 5.91 1 | 0.009 | |
Clinic 4 | 110 ± 16.5 | 103 ± 15.9 | −7.44 ± 5.59 | <0.0001 | |
Clinic 5 | 103 ± 10.5 | 96.6 ± 9.40 | −6.81 ± 6.90 | <0.0001 | |
Body fat percentage c | 0.006 | ||||
Clinic 1 | 44.5 ± 5.41 | 40.5 ± 7.62 | −4.03 ± 4.23 3,4,5 | <0.0001 | |
Clinic 2 | 44.5 ± 5.84 | 42.5 ± 6.30 | −2.00 ± 2.15 | <0.001 | |
Clinic 3 | 45.1 ± 5.57 | 43.8 ± 5.56 | −1.40 ± 2.35 1 | 0.015 | |
Clinic 4 | 44.8 ± 5.32 | 43.1 ± 4.79 | −1.69 ± 2.18 1 | <0.0001 | |
Clinic 5 | 45.3 ± 6.24 | 43.6 ± 5.99 | −1.75 ± 2.31 1 | <0.001 | |
Systolic blood pressure (mmHg) | 0.509 | ||||
Clinic 1 | 122 ± 12.2 | 120 ± 12.2 | −2.83 ± 13.2 | 0.213 | |
Clinic 2 | 119 ± 11.8 | 113 ± 12.4 | −6.04 ± 8.96 | <0.01 | |
Clinic 3 | 130 ± 18.3 | 123 ± 16.0 | −6.67 ± 10.9 | 0.011 | |
Clinic 4 | 125 ± 16.6 | 117 ± 13.7 | −8.04 ± 15.7 | 0.014 | |
Clinic 5 | 119 ± 11.1 | 116 ± 14.5 | −3.19 ± 12.3 | 0.190 | |
Diastolic blood pressure (mmHg) | 0.739 | ||||
Clinic 1 | 77.3 ± 6.81 | 72.8 ± 9.30 | −4.54 ± 9.14 | 0.006 | |
Clinic 2 | 74.8 ± 9.98 | 70.2 ± 10.2 | −4.60 ± 9.29 | 0.021 | |
Clinic 3 | 78.0 ± 12.2 | 75.0 ± 7.59 | −3.10 ± 8.61 | 0.115 | |
Clinic 4 | 75.8 ± 11.7 | 73.2 ± 9.27 | −2.56 ± 8.52 | 0.146 | |
Clinic 5 | 75.7 ± 7.75 | 71.9 ± 9.83 | −3.81 ± 8.95 | 0.036 |
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Share and Cite
Armenta-Guirado, B.; Martínez-Contreras, T.; Candia-Plata, M.C.; Esparza-Romero, J.; Martínez-Mir, R.; Haby, M.M.; Valencia, M.E.; Díaz-Zavala, R.G. Effectiveness of the Diabetes Prevention Program for Obesity Treatment in Real World Clinical Practice in a Middle-Income Country in Latin America. Nutrients 2019, 11, 2324. https://doi.org/10.3390/nu11102324
Armenta-Guirado B, Martínez-Contreras T, Candia-Plata MC, Esparza-Romero J, Martínez-Mir R, Haby MM, Valencia ME, Díaz-Zavala RG. Effectiveness of the Diabetes Prevention Program for Obesity Treatment in Real World Clinical Practice in a Middle-Income Country in Latin America. Nutrients. 2019; 11(10):2324. https://doi.org/10.3390/nu11102324
Chicago/Turabian StyleArmenta-Guirado, Brianda, Teresita Martínez-Contreras, Maria C. Candia-Plata, Julián Esparza-Romero, Raúl Martínez-Mir, Michelle M. Haby, Mauro E. Valencia, and Rolando G. Díaz-Zavala. 2019. "Effectiveness of the Diabetes Prevention Program for Obesity Treatment in Real World Clinical Practice in a Middle-Income Country in Latin America" Nutrients 11, no. 10: 2324. https://doi.org/10.3390/nu11102324
APA StyleArmenta-Guirado, B., Martínez-Contreras, T., Candia-Plata, M. C., Esparza-Romero, J., Martínez-Mir, R., Haby, M. M., Valencia, M. E., & Díaz-Zavala, R. G. (2019). Effectiveness of the Diabetes Prevention Program for Obesity Treatment in Real World Clinical Practice in a Middle-Income Country in Latin America. Nutrients, 11(10), 2324. https://doi.org/10.3390/nu11102324