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Lifestyle Intervention Could Benefit Older Adults With Diabetes
A study conducted by Michael E. DeBakey VA Medical Center researchers and published in the journal Diabetes Care found that a managed lifestyle intervention strategy may help improve both health and quality of life for older adults with diabetes.
May Not Be Too Late to Start, Findings Suggest
The study authors indicated that although lifestyle intervention is recommended as first-line treatment for diabetes regardless of age, it is still unclear whether this approach is effective for older adults in particular. Previous studies leading to the recommendation for lifestyle intervention as first-line treatment have typically involved younger people, and the limited research that has enrolled older adults with diabetes has generally included relatively healthy participants. The result, they noted, is that treatment recommendations for older adults with diabetes have relied on expert opinion instead of clinical trial data.
Older adults who have diabetes are not typically started on intensive lifestyle intervention even though it is considered the first line of management, explained Dennis T Villareal, MD, a professor of medicine in endocrinology, diabetes and metabolism at Baylor College of Medicine and staff physician at the Michael E. DeBakey VA Medical Center in Houston. “There’s a prevailing concept that it may be too late in life to start intensive lifestyle intervention,” he told Veterans Health Today. The thought is that diet and activity habits are so well-established at this point in life that it may be too difficult to change those habits.
Dr Villareal and colleagues set out to determine whether lifestyle intervention could improve outcomes in older adults with diabetes and comorbidities in order to provide evidence that could help inform treatment guidelines for this population. To learn more, they randomly assigned 100 older adults with diabetes to either a year-long intensive lifestyle intervention (ILI) group or a healthy lifestyle (HL) group. The ILI cohort included weight management, exercise training, and communication with dietitians and trainers. In contrast, the HL cohort involved monthly group educational sessions centered on healthy eating without weight loss or exercise programming.
According to the findings, an indicator of diabetes control (HbA1c) improved more in the ILI group, in addition to more significant weight loss and improved performance on physical tests. Those in the ILI group could also decrease their insulin doses. In terms of adverse events, there was a slightly higher number of hypoglycemia episodes observed in the ILI group compared with the HL group (30 vs 20). However, nearly all of these events were considered mild. The researchers concluded that “a lifestyle intervention program can be highly successful in older adults with diabetes and chronic comorbidities.” In other words, it may not be too late to begin lifestyle intervention in this population. (The average age of study participants was 72 years.)
According to Kristian Morey, RD, LDN, a clinical dietitian and Certified Diabetes Care & Education Specialist (CDCES) at Mercy Medical Center in Baltimore, MD, (who was not involved with the research), this study “confirms what we know for younger populations and now can be applied to older adults as well—that consistent, regular nutrition interventions, challenging exercise, and social support can greatly improve a person’s A1c and quality of life.”
She found it helpful to learn that physical performance improved in the ILI group despite some loss of lean body mass. In terms of practical takeaways that can be gleaned from this study, she said: “Encourage individuals to take advantage of the resources and benefits they have access to—from medical nutrition therapy and diabetes education from dietitians and diabetes educators to taking part in fitness programs like MOVE!, Gerofit, or SilverSneakers.”
Intensive Lifestyle Intervention Overview
The weight-management portion of the ILI involved group behavior therapy sessions as well as a curriculum geared toward food scales and nutrition labels, the modification of meals to lessen carbohydrates, and the implementation of various behavioral strategies. Participants met with a dietician weekly and were asked to come up with goals and attend weigh-ins. Upon review of food diaries, new goals were established. The aim was to reach a weight loss of about 10 percent of baseline body weight by six months and to maintain that for the remainder of the year. During the second half of the year, the frequency of meetings tapered off to once every two weeks.
The exercise training element of the ILI incorporated three weekly workouts over six months. The workouts lasted 90 minutes total, including 15 minutes of warm-up, 30 minutes of aerobic activity (treadmill, stationary biking, and stair climbing), 30 minutes of resistance training (upper and lower-body exercises on weight-lifting equipment), and 15 minutes devoted to balance. Following six months at a designated training facility, participants transitioned to community-fitness centers and homes for the remainder of the year.
A central question with the ILI group was whether these participants could comply with the program, explained Dr Villareal, and what he and colleagues found was that they were, indeed, able to stick with it. He credited the group dynamic as a helpful way of fostering supportive relationships. “They bond with each other, and they look out for each other,” he said, in addition to forming positive relationships with the dietician and exercise trainer.
The lifestyle changes were incorporated into their routine activities, especially as participants were discharged to the fitness centers of their choice. “We found that they were able to sustain that, so it seems that older adults as compared to younger are more compliant,” he said, although this could be at least in part because most participants were retired and not competing with job-related demands. “The most important part of the intensive lifestyle intervention, we think, is improving their quality of life,” Dr Villareal added.
Insurance Implications
The study’s findings could have insurance ramifications considering Medicare covers behavioral therapy focused on weight loss and an increasing number of plans offer memberships to health and fitness centers, the researchers pointed out. “Our lifestyle intervention program has the key characteristics of medical nutrition therapy (MNT) that are covered by Medicare Part B: intensive, focused, and comprehensive nutrition therapy provided by a nutritional professional, in-depth individualized nutrition assessment, setting of personal goals and care plans, and emphasis on follow-up counseling to provide reinforcement in changing behavior,” they wrote. In addition, the use of fitness centers may be covered via Medicare Part C or Medicare Supplement Insurance.
Additional Research Needed
The study received support from the American Diabetes Association, the National Institute of Diabetes and Digestive and Kidney Diseases, and the National Institutes of Health, along with resources provided by the Michael E. DeBakey VA Medical Center. Because it was limited to a one-year timeframe, Dr Villareal and colleagues emphasized the need for additional research to examine adherence over a longer duration and to see whether the beneficial impact of this form of therapy could reduce disease complications and their related costs.
