18th Feb 2014

MASS action program on diabetes appears to inspire weight loss among participants.

A landmark US diabetes prevention trial has shown that individuals who lost around 7% of their body weight reduced their diabetes risk by 58%.

Achieving these goals in the real world is another matter, yet a Victorian study has shown that a large-scale systematic diabetes prevention program can significantly reduce diabetes risk.

The Life! Taking Action on Diabetes program used 300 trained facilitators to give advice to around 8500 people at risk of diabetes in six group sessions over eight months.

Participants lost an average 2.4kg and reduced their waist circumference by 3.8cm, representing about 2.7% of their starting body weight, which extrapolates to a 21—39% reduced risk of diabetes.

Lead investigator Professor James Dunbar, director of the Greater Green Triangle University Department of Rural Health at Flinders and Deakin universities, says it’s a significant improvement. “One of the great myths is you have to lose a lot of weight,” he says. “Actually the first 3kg is what makes the big difference.”

Professor Dunbar says Life! lacked Medicare funding for cholesterol measurements at three months, but the pilot trial, which did include cholesterol measurements, showed that the protocol also reduced cardiovascular risk by 16%.

He says the key to the success of the program, which cost approximately $450 per participant, was using behavioural change theories pioneered in a Finnish diabetes prevention study.

The Health Action Process Approach model encourages participants to use problem-solving and goal-setting to change their diet and activity.

“The facilitators are trained to get participants to make changes for themselves about what they are going to do rather than pumping facts and figures at them,” Professor Dunbar says.

He says Life! was designed for GPs — who don’t have time to coach their patients to lose weight — to refer to the program.

While Life! does not have long-term data, participants in the pilot have been followed for 30 months and diabetes risk reduction is being maintained.

Professor Dunbar says the Finnish program, from which Life! was derived, showed that diabetes risk was reduced by 37% even after 13 years.

“So even though people start to put on weight again and slip in their habits, the reduction in risk of progression of diabetes is dramatically reduced,” he says.

Professor Dunbar says Diabetes Australia aims to roll out the Life! program Australia-wide.

Diabetes Care 2013; online 6 Dec