Lifestyle intervention by group-based rehabilitation versus individual counseling in type 2 diabetes: 1-year follow-up of the Copenhagen type 2 diabetes rehabilitation project

Eva Soelberg Vadstrup, A. Frølich, H. Perrild, E. Borg, M. Røder

Department of Cardiology and Endocrinology, Hiller?d University Hospital, Hiller?d, Denmark.
Department of Endocrinology and Gastroenterology, Bispebjerg University Hospital, Copenhagen, Denmark.
Department of Integrated Healthcare, Bispebjerg University Hospital, Copenhagen, Denmark.
Health Care Center Oesterbro, Copenhagen, Denmark.

DOI: 10.4236/jdm.2012.23048                

Abstract

Background: Today most guidelines on the management of type 2 diabetes incorporate lifestyle intervention including patient education, physical activity and dietary modification. However, the content and organization of lifestyle intervention programs are still debatable. Aims: To compare the longer term effectiveness of a group-based rehabilitation program with an individual counseling program at improving glycemic control, cardiovascular risk factors and quality of life among type 2 diabetes patients. Methods: We randomized 143 type 2 diabetes patients to either a 6-month group-based rehabilitation program, including patient education, supervised exercise, and diet intervention, or a 6-month individual counseling program. Follow-up time was 12 months after baseline. Outcome measures were glycated hemoglobin (HbA_1c), cardiovascular risk factors, quality-of-life and self-rated health. Results: In the rehabilitation group, HbA_1c decreased 0.2%-point (95% confidence interval [CI] = -0.4, -0.03), systolic blood pressure decreased 6 mmHg (95% CI = -9.3, -2.5), diastolic blood pressure decreased 4 mmHg (95% CI = -6.3, -2.4), weight decreased 2.2 kg (95% CI = -3.2, -1.3), and waist circumference decreased 2.0 cm (95% CI = -2.9, -1.1). In the individual group, HbA1c decreased 0.4% (95% CI = -0.6, -0.1), systolic blood pressure decreased 3 mmHg (95% CI = -6.3, -0.7), diastolic blood pressure decreased 3 mmHg (95% CI = -4.7, -0.7), weight decreased 1.6 kg (95% CI = -2.6, -.7]), and waist circumference decreased 1.6 cm (95% CI = -2.5, -0.6). Vitality, fatigue distress, physical functioning and cardiovascular distress improved over time (P < 0.05) in the two groups combined. Repeated measurement analysis did not result in significant differences between the groups of any outcome. Conclusions: This study demonstrates that group-based rehabilitation in a primary healthcare center is a comparable alternative to individual counseling in an outpatient clinic. However, the resource use of the rehabilitation program was twice as much as the individual program.

Keywords

Rehabilitation; Lifestyle Intervention; Glycemic Control; Quality of Life; Cardiovascular Risk Factors

Conflicts of Interest

The authors declare no conflicts of interest.

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