Austin Health – Diabetes Lifestyle Change Program
Nicki Gazis – HARP PsychologyAlan McCubbin – HARP DietitianBrett Gordon – Physiotherapy Richard MacIsaac – Endocrinology
• Translating evidence from clinical trials into evidence based
• Representativeness of trial samples• Generalizability to clinical settings• AH-DLCP modifications• Program outcomes
Clinical Trials
Diabetes Prevention Program (DPP): Aim: To test ability of intensive lifestyle intervention, metformin, or
placebo to prevent or delay type 2 diabetes in high risk adults
Sample: N = 2766; impaired glucose tolerance Results: Diabetes incidence at 10 years reduced by 34% in
lifestyle group and 18% in the metformin group compared with placebo
DPP Research Group. (2009). 10-year follow-up of diabetes incidence and weight loss in the Diabetes
Prevention Program Outcomes Study. Lancet, 14: 1677-1686.
Clinical Trials
Look Ahead: Aim: to test effectiveness of Intensive Lifestyle Intervention or
Diabetes Support and Education to reduce CVD risk
Sample: N = 5,145; BMI ≥ 25; type 2 diabetes Results: At one year ILI lost 8.6% of baseline body weight
compared with .7% in DSE. ILI improved glycaemic control, reduced CVD risk factors and reduce medications
Look Ahead Research Group. (2007). Reduction in weight and cardiovascular disease risk factors in individuals
with type 2 diabetes: One-year results of the Look AHEAD trial. Diabetes Care, 30: 1374-1383.
AH-DLCP vs. Look Ahead Baseline Look Ahead P value Characteristics N = 2,570 N = 58 AH-DLCP Patient Characteristics
• 29% Evidence or some evidence of diabetes complications
• 22% Chronic obstructive pulmonary disease
Diabetes distress - PAID
Positively associated with• General emotional distress• Disordered eating • Fear of short and long term complications• HbA c – blood sugar control
Negatively associated• Adherence to self care behaviours
Polonsky, W.H., Anderson, B.J., Lohrer, P.A., Welch, G., Jacobosn, A.M., Aponte, J.E., et al.
(1995).Assessment of diabetes related distress. Diabetes Distress, 18, 754-760. Comparisons of depression Look Ahead AH-DLCP Diabetes distress Characteristics Diabetes No Diabetes P Value Distress N = 13 Distress N = 45 Depression and Weight Loss Program: University of Massachusetts Memorial Medical Centre –
Diabetes Prevention Program (UMMC DPP) – hospital-base lifestyle change program modelled after the DPP
Sample: N = 131 obese patients, 17% MDD, 21% type 2 diabetes, Result: Patients with MDD only achieved 63% of weight loss
Pagoto, S., Bodenlos, J.S., Kantor L., Gitkind, M., Curtin, C., & Ma, Y. (2007). Association of Major Depression
and Binge Eating Disorder with weight loss in a clinical setting. Obesity, 15, 2557-2559. UMMC DPP Modifications
• Aim: weight loss ≥ 5%• Reduction in number of individual sessions
DPP – 16 individual sessions over 24 weeks followed by monthly contact up to 1 year
• Replaced with a 16 week core group program• Replaced community case managers with specialist hospital
• Core group program delivered by clinical psychologist, exercise
AH-DLCP Modifications Part 1 • Sixteen weekly group sessions • Delivered by clinical psychologist, exercise physiologist, dietitian • Patients with diabetes distress referred for individual counselling Part 2 • Exercise Program – 16 weekly sessions • Conducted in hospital gymnasium • Supervised by Exercise Physiologist AH-DLCP vs. UMMC DPP Weight Change No MDD- DD* AH-DLCP Weight Change DD vs. No DD AH-DLCP Weight Change
diabetes distress loss 2.8% of baseline body weight compared
51% with no diabetes distress (p =
AH-DLCP PAID score change DD vs. No DD
• Diabetes distress participants reduced their PAID score by 42%
PAID Score Change
compared with the 26% among the no DD group (p = .05)
were clinically distressed (p < .001)
Reductions in HbA c
• AH-DLCP participants (N = 24)
HbA1c: AH-DLCP vs. Look Ahead
• AH-DLCP older, more insulin dependent, higher glucose and
cholesterol levels, higher number of co morbidities than Look Ahead
• Modifications have produced results comparing favourably with
• Total sample achieved 4.5% reduction in body weight• 48% met ≥ 5% weight loss target• 46% fewer patients were clinical distressed post program• HbA c reduced significantly and clinically to below optimal level
HD 1920X1080P High-definition cameras instructions Thank you for purchasing D300 HD 1080P high-definition video DV, the machine adopts unique super portable design, make it can be used in every field, bring you convenience, safety, rich and 一． Product characteristics. Compact shape design of product, carry out the whole machine grinds arenaceous, fashionable wear-resis
HIVQUAL-U Manual Data Collection Form (version 4) Adult/Adolescent Start Date: XX/ XX/ XXXX End Date: XX/XX/XXXX Patient Profile Patient Data Entry Screen 1: “Monitoring HIV Status and Continuity of Care” 1.1 Did the patient have any CD4 counts during the review period? Yes No Not stated • If no, go to 1.1.2 1.1.1 ( If yes in 1.1 ) Record
Austin Health – Diabetes Lifestyle 
• Translating evidence from clinical trials into evidence based
• Representativeness of trial samples• Generalizability to clinical settings• AH-DLCP modifications• Program outcomes
Clinical Trials
Clinical Trials
AH-DLCP vs. Look Ahead
AH-DLCP Patient Characteristics
Diabetes distress - PAID
Comparisons of depression
AH-DLCP Diabetes distress
Depression and Weight Loss
UMMC DPP Modifications
AH-DLCP Modifications
AH-DLCP vs. UMMC DPP
AH-DLCP Weight Change DD vs. No DD
AH-DLCP PAID score change DD vs. No DD
Reductions in HbA c
• AH-DLCP older, more insulin dependent, higher glucose and
cholesterol levels, higher number of co morbidities than Look Ahead
• Modifications have produced results comparing favourably with
• Total sample achieved 4.5% reduction in body weight• 48% met ≥ 5% weight loss target• 46% fewer patients were clinical distressed post program• HbA c reduced significantly and clinically to below optimal level