Posted Jan 9 , 2018 02:26 AM

Evaluation of a type 2 diabetes prevention program using a commercial weight management provider for nondiabetic hyperglycemic patients referred by primary care in the UK

Piper C, et al. BMJ Open Diab Res Care 2017;5:e000418

What were the findings (excerpted from the Abstract)?

The purpose of this study was to determine if a diabetes prevention program (DPP) delivered by a commercial weight management provider using a UK primary care referral pathway could reduce the progression to type 2 diabetes (T2D) in those diagnosed with non-diabetic hyperglycemia (NDH—being at high risk of developing T2D). This is a quasi-experimental translational research study. Fourteen (14) primary care practices identified, recruited and referred patients with NDH (fasting plasma glucose ≥ 5.5 to ≤ 6.9 mmol/L (100 to 125 mg/dL) and/or glycated hemoglobin (HbA1c) ≥ 42 to 47 mmol/mol (6.0%–6.4%)) and a body mass index (BMI) ≥ 30 kg/m2 to a DPP. Eligible patients were asked to contact Weight Watchers to book onto their DPP, an intensive lifestyle intervention which included a 90-min activation session followed by the offer of 48 weekly Weight Watchers community group meetings. Patients’ blood tests were repeated by primary care, weight change plus self-reported data was recorded by Weight Watchers. Patients (166) were referred to the program and 149 were eligible. Seventy nine percent of eligible patients attended an activation session (117 eligible patients) and 77% started the weekly sessions. The study sample was primarily female (75%), white (90%), with 5% living in the most deprived quintile in the UK. Using intention-to-treat analysis, the DPP resulted in a significant mean reduction in A1C at 12 months from 43.42 to 40.58 mmol/mol (6.12% to 5.86%) Thirty eight percent (38%) of patients returned to normoglycemia and 3% developed T2D at 12 months. There was a mean weight reduction in BMI of 3.2 kg/m2 at 12 months, which represented 10 kg (22 pounds). Using a primary care referral route partnering with this commercial weight management provider can deliver an effective DPP. The weight loss achieved in the intervention translated into considerable reductions in potential diabetes risk.

Why is this important?
This study, like many others, confirms how important weight management is to prevention of diabetes. It is important to note that the weight reduction associated with Weight Watchers has been shown to be superior to self-initiated dietary changes (Marrero D, et al American Journal of Public Health 2016;106:949-956). It is also important to note that the participants in this study were given vouchers that allowed them to attend 40 monthly sessions at no charge. Despite this, 25% of eligible patients did not attend the initial session, and another 16% did not complete the sessions or were lost to follow-up. While there are a variety of program structures within Weight Watchers, meetings [studied in this article] run about $382 for 12 months. It would be interesting to see what proportion of patients would follow through if the costs were not covered. Clearly, this is a mechanism to help patients lose weight and change lifestyle [including activity] and is a cost that should be reimbursed if patients participated and lost weight. It is interesting that the current CPT codes and provider payment for 6 months of obesity counseling face-to-face (G0477 followed by G0473) is more than the cost of Weight Watchers for 12 months…

Do you refer patients with obesity to a commercial weight management program such as Weight Watchers? Do you provide obesity counseling for patients with BMI over 30 kg/m2? Do you use both?

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