Upstate News

February 16, 2009
Doretta Royer 315 464-4833

SUNY Upstate awarded $3.2 million NIH grant to see if telephone interventions can prevent diabetes

SYRACUSE, N.Y. — SUNY Upstate Medical University researchers are conducting a $3.2 million NIH-funded study to determine if patients at increased risk for diabetes can successfully lose weight and increase activity levels through a medication-free weight loss program that is delivered by telephone by primary care providers. This study also tests the effectiveness of individual telephone interventions vs. group telephone interventions.

The five-year study “Weight Loss in Primary Care: A Translation of the Diabetes Prevention Program,” or locally titled “The Support, Health Information, Nutrition and Exercise” (SHINE) program, is funded by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). SUNY Upstate principal investigators are Paula Trief, Ph.D., professor of psychiatry and behavioral sciences and medicine, and Ruth Weinstock, M.D., Ph.D., division chief of Endocrinology, Diabetes and Metabolism in the Department of Medicine and director of the Joslin Diabetes Center.

“This significant study to be conducted at one of New York’s premier Diabetes Centers of Excellence will test an exciting new primary care based approach to preventing obesity and the diabetes that frequently accompanies obesity,” said New York State Health Commissioner Richard F. Daines, M.D., who visited the Joslin Center Feb. 10 to be updated on the study.

According to Weinstock, obesity is related to the rising incidence of type 2 diabetes and interventions leading to sustained weight loss are needed.

“Most weight loss research studies have been implemented in academic centers under tightly controlled conditions with limited follow-up,” said Weinstock. “The need for the translation of successful interventions, such as the Diabetes Prevention Program (DPP), is clear. Since patients have regular contact with their primary care physicians, an intervention that can be delivered through primary care practices could have better long-term outcomes.”

The weight loss intervention program translates the Diabetes Prevention Program (DPP) as its model for a successful weight loss intervention. The DPP was a major multicenter clinical research study that found, in part, that participants who lost a modest amount of weight through dietary changes and increased physical activity sharply reduced their chances of developing diabetes.

“No programs to date have successfully adapted the DPP to a long-term primary care-based intervention,” said Trief.

The SUNY Upstate study is a randomized controlled trial of two active treatment interventions based on the DPP model that will be delivered at four primary care sites. The specific aims are to evaluate the effects of two interventions that are translations of the DPP Lifestyle Balance program and are delivered through primary care practices, on the primary medical outcome of weight loss, secondary medical outcomes of blood pressure, fasting lipids and glycemia, and psychosocial outcomes of health behaviors and health-related quality of life.

The secondary aims are to determine whether the DPP translation is more effective and/or cost effective if delivered in a group format.

Study participants are men and women aged 18 years or older who are being recruited from four primary care sites: University Internists at Harrison Center, Oneida Healthcare, Pulaski Healthcare and the Syracuse Community Health Center. There are two active treatment groups, both based on the DPP Lifestyle Balance Program.

Participants work with educators from their primary care provider’s practice, including nurses, nutritionists and other specialties, and also with weight loss “coaches.”

During the first year, in one group, the educator will present the 16 DPP topics, such as strategies for healthy eating and increased physical activity, during phone calls, weekly for first five weeks, monthly thereafter. The coach will also make monthly phone contacts to promote adherence to these behavioral weight loss strategies. Contact will decrease to monthly in year two and, in year three, there will be no contact arranged by study staff.

In the second group, the educator will facilitate group conference calls, weekly for the first five weeks, monthly thereafter, to present the DPP material and foster peer support. The coach will also conduct monthly group phone contacts. A second year of continued contact is included.

“The study is significant because a primary care based, telephone weight loss intervention will be able to reach more people, may be more effective, and could be easily adopted by primary care physicians, helping them help their patients lose weight successfully and maintain their weight loss,” said Trief. “Interventions leading to sustained weight loss are needed to improve the public health and reverse the rise in diabetes, its cardiovascular complications and other obesity-related illnesses.”

Commissioner Daines noted that over 1.1 million New Yorkers, or nearly eight percent ofthe population, are diagnosed with diabetes and thousands more are living with undiagnosed diabetes.

“Our best hope of slowing and eventually reversing the current obesity and diabetes epidemic is the use of effective preventive techniques like those being used at the Joslin Center.

“To help support these efforts, Governor Paterson included new Medicaid funding in this year’s state budget to compensate diabetes educators for providing diabetes education, counseling and self-management techniques to patients.”

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