Programs designed to promote diet and physical activity, specifically geared toward individuals at high risk for developing type 2 diabetes, can be effective at reducing the number of new-onset diabetes cases, according to a recommendation from the Community Preventive Services Task Force.

The recommendation was derived from a review of 53 studies examining 66 programs already in place across the nation, which presented a consensus that promoting dietary changes and increased physical activity in either a clinical or community engagement setting can significantly decrease the risk of at-risk individuals to develop type 2 diabetes (Ann. Intern. Med. 2015 July 13 [doi:10.7326/M15-1029]).

These programs vary in several ways – length, method of delivery, and individual versus group-based activities – but all share the common goal of education and awareness of diabetes and measures to prevent it.

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“Programs commonly include a weight-loss goal, individual or group sessions (or both) about diet and exercise, meetings with a trained diet or exercise counselor (or both), and individually tailored diet or exercise plans (or both),” wrote Dr. Nicolaas P. Pronk and Dr. Patrick L. Remington. “Higher-intensity programs lead to greater weight loss and reduction in new-onset diabetes.”

From a search of MEDLINE, the Cochrane Central Register of Controlled Trials, CAB Abstracts, Global Health, and Ovid HealthSTAR from 1991 through 2015, investigators with the Community Preventive Services Task Force included randomized, controlled trials and prospective nonrandomized comparative studies of at least 30 participants. All programs examined by the included studies ran from 3 months to 6 years in length, with all but 5 programs being longer than 6 months. Programs mostly used in-person exercises, either individually or in a group setting, focusing on diet improvement or exercise.

Programs were typically led by nutritionists or physical trainers, but several were also led by physicians, psychologists, nurses, or a “trained layperson.” The recommendations highlight that while some programs had participants outline specific goals and all programs varied in the intensity and style of their counseling, they all led to either reduced risk of diabetes, weight loss, or both.

“In 17 studies that reported blood pressure outcomes and 14 that reported lipid outcomes, programs reduced systolic and diastolic blood pressures and improved lipid levels, including total, low-density lipoprotein, and high-density lipoprotein cholesterol levels and triglyceride levels,” the recommendations state, adding that no long-term ramifications were reported relating to any of the programs.

Economic review of 28 programs indicated that median program cost per participant was $653, although this cost was substantially lower for programs in either community or primary care-based settings (median cost of $424) and group-based programs (median cost of $417). While these costs can be prohibitively high for many Americans, the recommendations advise that many employers list health programs as a covered benefit, and urges private and public health insurers to join in covering participation costs. Most programs also offer free information online.

The Community Preventive Services Task Force is an independent, unpaid, nonfederal body. Dr. Pronk and Dr. Remington did not report any relevant financial disclosures.

What is the Community Preventive Services Task Force?

The U.S. Community Preventive Services Task Force was created in 1996 by the U.S. Department of Health and Human Services with the goal of making recommendations and identifying evidence gaps in existing knowledge and research to “help inform the decision making of federal, state, and local health departments, other government agencies, communities, healthcare providers, employers, schools and research organizations.”

These findings are released as The Community Guide, which collects information on studies of relevant public health topics, assesses the strengths and weaknesses of these studies and their findings, and summarizes the evidence in a way that presents whether or not intervention is necessary, how to make an intervention the most effective it can be, what costs would be associated with such an intervention, and what gaps in our existing knowledge or research exist that should be rectified.

As of passage of the Patient Protection and Affordable Care Act in 2010, the task force’s findings are collected in an annual report presented to Congress, which has mandated the Centers for Disease Control and Prevention to support the work of the task force even though the task force is considered an independent, nonfederal, unpaid body. However, according to a disclaimer from the task force’s most recent clinical guideline, “recommendations made by the Task Force are independent of the U.S. government and should not be construed as an official position of the Centers for Disease Control and Prevention or the U.S. Department of Health and Human Services.

The 14 current members of the task force come from across the country, and from both the private and public spheres. The task force is chaired by Dr. Jonathan E. Fielding, director of and a health officer in the Los Angeles County Department of Health.

dchitnis@frontlinemedcom.com

Diet, exercise programs increasingly effective at reducing type 2 diabetes risk