title: Effects of a structured health education programme by a diabetic education nurse on cardiovascular risk factors in Chinese Type 2 diabetic patients: a 1-year prospective randomized study. Weight Loss, Glycemic Control, and Cardiovascular Disease Risk Factors in Response to Differential Diet Composition in a Weight Loss Program in Type 2 Diabetes: A Randomized Controlled Trial Effect of Exercise on Blood Pressure in Type 2 Diabetes: A Randomized Controlled Trial Effects of a 12-month physical activity counselling intervention on glycaemic control and on the status of cardiovascular risk factors in people with Type 2 diabetes Biophysiologic outcomes of the Enhancing Adherence in Type 2 Diabetes (ENHANCE) trial. Long-term lifestyle intervention lowers the incidence of stroke in Japanese patients with type 2 diabetes: a nationwide multicentre randomised controlled trial (the Japan Diabetes Complications Study) Case management for patients with poorly controlled diabetes: a randomized trial. A Pharmacist Care Program The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials Reduction in Weight and Cardiovascular Disease Risk Factors in Individuals With Type 2 Diabetes Effectiveness of PRECEDE model for health education on changes and level of control of HbA1c, blood pressure, lipids, and body mass index in patients with type 2 diabetes mellitus Long-term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes mellitus: four-year results of the Look AHEAD trial. Prescription of physical activity is not sufficient to change sedentary behavior and improve glycemic control in type 2 diabetes patients. Multifactorial intervention in individuals with type 2 diabetes and microalbuminuria: the Microalbuminuria Education and Medication Optimisation (MEMO) study. Lifestyle intervention by group care prevents deterioration of Type II diabetes: a 4-year randomized controlled clinical trial The anti-inflammatory effects of exercise training in patients with type 2 diabetes mellitus Effect of an intensive exercise intervention strategy on modifiable cardiovascular risk factors in subjects with type 2 diabetes mellitus: a randomized controlled trial: the Italian Diabetes and Exercise Study (IDES). Nutritional intervention in patients with type 2 diabetes who are hyperglycaemic despite optimised drug treatment—Lifestyle Over and Above Drugs in Diabetes (LOADD) study: randomised controlled trial Culturally sensitive patient-centred educational programme for self-management of type 2 diabetes: a randomized controlled trial.
abstract: AIMS To assess the effect of regular diabetic health education on cardiovascular risk factors in Chinese Type 2 diabetic patients . METHODS This was a 1-year prospect i ve r and omized study . One hundred and eighty Type 2 diabetic subjects were recruited from three regional diabetic centres in Hong Kong . Ninety received additional structured reinforcement of diabetic health education by a trained nurse after the doctors ' consultations every 3 months ( intervention group ) . The others received the same medical care except no nursing reinforcement ( control group ) . Outcome measures included fasting plasma glucose , HbA(1c ) , body mass index , waist circumference , blood pressure and lipid profiles , which were assessed before the study and after 1 year . RESULTS Two of the controls defaulted follow-up . The intervention group and controls had similar age and sex distribution . At the end of study , the intervention group had reducted their waist circumference , diastolic blood pressure , HbA(1c ) , total cholesterol and low-density lipoprotein cholesterol levels . The controls had reduced their total cholesterol and low-density lipoprotein cholesterol levels . Other cardiovascular risk factors were not significantly changed in the controls . Addition of drugs and /or dosage increment of anti-diabetic drugs , lipid-lowering agents and anti-hypertensive agents were similar between the two groups . CONCLUSIONS Regular structured reinforcement with diabetic health education is useful . It helps to control more successfully some of the cardiovascular risk factors in Chinese Type 2 diabetic patients OBJECTIVE To test whether a weight loss program promotes greater weight loss , glycemic control , and improved cardiovascular disease risk factors compared with control conditions and whether there is a differential response to higher versus lower carbohydrate intake . RESEARCH DESIGN AND METHODS This r and omized controlled trial at two university medical centers enrolled 227 overweight or obese adults with type 2 diabetes and assigned them to parallel in-person diet and exercise counseling , with prepackaged foods in a planned menu during the initial phase , or to usual care ( UC ; two weight loss counseling sessions and monthly contacts ) . RESULTS Relative weight loss was 7.4 % ( 95 % CI 5.7–9.2 % ) , 9.0 % ( 7.1–10.9 % ) , and 2.5 % ( 1.3–3.8 % ) for the lower fat , lower carbohydrate , and UC groups ( P < 0.001 intervention effect ) . Glycemic control markers and triglyceride levels were lower in the intervention groups compared with UC group at 1 year ( fasting glucose 141 [ 95 % CI 133–149 ] vs. 159 [ 144–174 ] mg/dL , P = 0.023 ; hemoglobin A1c 6.9 % [ 6.6–7.1 % ] vs. 7.5 % [ 7.1–7.9 % ] or 52 [ 49–54 ] vs. 58 [ 54–63 ] mmol/mol , P = 0.001 ; triglycerides 148 [ 134–163 ] vs. 204 [ 173–234 ] mg/dL , P < 0.001 ) . The lower versus higher carbohydrate groups maintained lower hemoglobin A1c ( 6.6 % [ 95 % CI 6.3–6.8 % ] vs. 7.2 % [ 6.8–7.5 % ] or 49 [ 45–51 ] vs. 55 [ 51–58 ] mmol/mol ) at 1 year ( P = 0.008 ) . CONCLUSIONS The weight loss program result ed in greater weight loss and improved glycemic control in type 2 diabetes BACKGROUND Increased blood pressure ( BP ) in type 2 diabetes ( T2DM ) markedly increases cardiovascular disease morbidity and mortality risk compared to having increased BP alone . OBJECTIVE To investigate whether exercise reduces suboptimal levels of untreated suboptimal BP or treated hypertension . DESIGN Prospect i ve , r and omized controlled trial for 6 months . SETTING Single center in Baltimore , MD , USA . PATIENTS 140 participants with T2DM not requiring insulin and untreated SBP of 120–159 or DBP of 85–99 mmHg , or , if being treated for hypertension , any SBP < 159 mmHg or DBP < 99 mmHg ; 114 completed the study . INTERVENTIONS upervised exercise , 3 times per week for 6 months compared with general advice about physical activity .  MEASUREMENTS Resting SBP and DBP ( primary outcome ) ; diabetes status , arterial stiffness assessed as carotid-femoral pulse-wave velocity ( PWV ) , body composition and fitness ( secondary outcomes ) . RESULTS Overall baseline BP was 126.8 ± 13.5 / 71.7 ± 9.0 mmHg , with no group differences . At 6 months , BP was unchanged from baseline in either group , BP 125.8 ± 13.2 / 70.7 ± 8.8 mmHg in controls ; and 126.0 ± 14.2 / 70.3 ± 9.0 mmHg in exercisers , despite attaining a training effects as evidence d by increased aerobic and strength fitness and lean mass and reduced fat mass ( all p < 0.05 ) , Overall baseline PWV was 959.9 ± 333.1 cm/s , with no group difference . At 6-months , PWV did not change and was not different between group ; exercisers , 923.7 ± 319.8 cm/s , 905.5 ± 344.7 , controls . LIMITATIONS A completion rate of 81 % . CONCLUSIONS Though exercisers improve fitness and body composition , there were no reductions in BP . The lack of change in arterial stiffness suggests a resistance to exercise-induced BP reduction in persons with T2DM Aims /hypothesisThe aim of this study was to investigate the effectiveness of physical activity counselling in promoting physical activity in people with Type 2 diabetes and to evaluate result ant physiological and biochemical effects . Methods A total of 70 inactive people with Type 2 diabetes were given st and ard exercise information and r and omised to receive physical activity counselling ( n=35 , experimental ) or not ( n=35 , control ) . Physical activity consultations were delivered at baseline and after 6 months , with follow-up phone calls after 1 , 3 , 6 and 9 months . Changes from baseline after 6 and 12 months were assessed for physical activity ( 7-day recall and accelerometer ) , for physiological characteristics ( body mass index and blood pressure ) and for biochemical variables ( HbA1c , lipid profile , fibrinogen , tissue plasminogen activator and microalbuminuria ) . Results Significant differences between groups were recorded for physical activity after 6 and 12 months ( p<0.01 ) . The experimental group had increased levels of physical activity from baseline to 6 months ( p<0.01 ) , with no decrease from 6 to 12 months ( p>0.05 ) . In the control group , accelerometer counts per week decreased from baseline to 12 months ( p=0.03 ) . Between-group differences ( p<0.05 ) were recorded for the change in HbA1c ( experimental : 0.26 % decrease ; control : 0.15 % increase ) , for systolic blood pressure ( experimental : 7.7 mm Hg decrease ; control : 5.6 mm Hg increase ) and for fibrinogen ( experimental : 0.28 mmol/l decrease ; control : 1.43 mmol/l increase ) from baseline to 6 months , and for total cholesterol ( experimental : 0.33 mmol/l decrease ; control : 0.04 mmol/l increase ) from baseline to 12 months ( p<0.05 ) . No significant differences were recorded in other measured variables . Conclusions /interpretationsPhysical activity counselling was effective in promoting physical activity in people with Type 2 diabetes . The counselling improved glycaemic control as well as the status of cardiovascular risk factors in these patients BACKGROUND Behavioral research to improve lifestyle in broadly defined population s of patients with type 2 diabetes is limited . OBJECTIVE We evaluated a behavioral intervention featuring technology-based self-monitoring on biophysiologic outcomes of glycemic control and markers of cardiovascular risk . DESIGN In this single-site , r and omized clinical trial , participants were stratified by good and poor glycemic control ( glycated hemoglobin < 8 % or ≥8 % ) and absence or presence of kidney disease , ( estimated glomerular filtration rate ≥60 or < 60 mL/min ) and r and omized within strata . Measurements were obtained at 0 , 3 , and 6 months . PARTICIPANTS / SETTING Self-referred , community-dwelling adults with type 2 diabetes mellitus . INTERVENTION The intervention group received Social Cognitive Theory-based counseling paired with technology-based self-monitoring , and results were compared with an attention control group . MAIN OUTCOME MEASURES Glycated hemoglobin , fasting serum glucose , lipid levels , blood pressure , weight , body mass index , and waist circumference were evaluated . STATISTICAL ANALYSES PERFORMED Mean differences within and between r and omization groups were compared over time . Intervention effects over time were estimated using r and om intercept models . RESULTS Two hundred ninety-six subjects were r and omized , 256 ( 86.5 % ) completed 3-month and 246 ( 83.1 % ) completed 6-month assessment s. Glycated hemoglobin was reduced in the intervention group by 0.5 % at 3 months and 0.6 % at 6 months ( P<0.001 for each ) , and the control group by 0.3 % ( P<0.001 ) at 3 months and 0.2 % ( P<0.05 ) at 6 months ; but between-group differences were not significant . In those with baseline glycated hemoglobin ≥8 % and estimated glomerular filtration rate ≥60 mL/min , glycated hemoglobin was reduced in the intervention group by 1.5 % at 3 months and 1.8 % at 6 months ( P<0.001 for each ) , and the control group by 0.9 % ( P<0.001 ) at 3 months and 0.8 % ( P<0.05 ) at 6 months ; but between-group differences were not significant . In r and om intercept models , the estimated reduction in glycated hemoglobin of 0.29 % was not significant . CONCLUSIONS Two behavioral approaches to improving general lifestyle management in individuals with type 2 diabetes mellitus were effective in improving glycemic control , but no significant between-group differences were observed Aims /hypothesisThe aim of the study was to clarify whether a therapeutic intervention focused on lifestyle modification affected the incidence of vascular complications in patients with established diabetes . Methods A total of 2,033 eligible Japanese men and women aged 40–70 years with type 2 diabetes from 59 institutes were r and omised to a conventional treatment group ( CON ) , which continued to receive the usual care , and a lifestyle intervention group ( INT ) , which received education on lifestyle modification regarding dietary habits , physical activities and adherence to treatment by telephone counselling and at each outpatient clinic visit , in addition to the usual care . R and omisation and open-label allocation were done by a central computer system . Primary analysis regarding measurements of control status and occurrence of macro- and microvascular complications was based on 1,304 participants followed for an 8 year period . Results Although status of control of most classic cardiovascular risk factors , including body weight , glycaemia , serum lipids and BP , did not differ between groups during the study period , the incidence of stroke in the INT group ( 5.48/1,000 patient-years ) was significantly lower than in the CON group ( 9.52/1,000 patient-years ) by Kaplan – Meier analysis ( p = 0.02 by logrank test ) and by multivariate Cox analysis ( HR 0.62 , 95 % CI 0.39–0.98 , p = 0.04 ) . The incidence of CHD , retinopathy and nephropathy did not differ significantly between groups . Lipoprotein(a ) was another significant independent risk factor for stroke . Conclusions /interpretationThese findings suggest that lifestyle modification had limited effects on most typical control variables , but did have a significant effect on stroke incidence in patients with established type 2 diabetes . Clinical Trial Registration : UMIN-CTR C000000222 Funding : The Ministry of Health , Labour and Welfare , PURPOSE To evaluate the effects of a collaborative case management intervention for patients with poorly controlled type 2 diabetes on glycemic control , intermediate cardiovascular outcomes , satisfaction with care , and re source utilization . METHODS We conducted a r and omized controlled trial at two Department of Veterans Affairs Medical Centers involving 246 veterans with diabetes and baseline hemoglobin A(1C ) ( HbA(1C ) ) levels > or=7.5 % . Two nurse practitioner case managers worked with patients and their primary care providers , monitoring and coordinating care for the intervention group for 18 months through the use of telephone contacts , collaborative goal setting , and treatment algorithms . Control patients received educational material s and usual care from their primary care providers . RESULTS At the conclusion of the study , both case management and control patients remained under poor glycemic control and there was little difference between groups in mean exit HbA(1C ) level ( 9.3 % vs. 9.2 % ; difference = 0.1 % ; 95 % confidence interval : -0.4 % to 0.7 % ; P = 0.65 ) . There was also no evidence that the intervention result ed in improvements in low-density lipoprotein cholesterol level or blood pressure control or greater intensification in medication therapy . However , intervention patients were substantially more satisfied with their diabetes care , with 82 % rating their providers as better than average compared with 64 % of patients in the control group ( P = 0.04 ) . CONCLUSION An intervention of collaborative case management did not improve key physiologic outcomes for high-risk patients with type 2 diabetes . The type of patients targeted for intervention , organizational factors , and program structure are likely critical determinants of the effectiveness of case management . Health systems must underst and the potential limitations before expending substantial re sources on case management , as the expected improvements in outcomes and downstream cost savings may not always be realized Objective : To investigate the effect of a pharmacist care program on cardiovascular risks in type 2 diabetic patients . Methods : A 9-month , prospect i ve , r and omized , controlled study was conducted in a public hospital in Hong Kong . Patients in the intervention group had regular drug-counseling sessions with pharmacists in addition to routine medical care , whereas patients in the control group received only routine medical care . The primary outcome was the change in coronary heart disease ( CHD ) risk . Results : A total of 105 patients completed the study . Patients in the intervention group had a statistically significant reduction in CHD risk compared to those in the control group ( −1.64 % ± 3.56 % ; n = 51 vs −0.01 % ± 3.08 % ; n = 54 , P = .013 ) . For stroke , a reduction in risk was noted in the intervention group , while an increased risk was noted in the control group ( −1.06 % ± 1.82 % vs 0.31 % ± 2.51 % , P = .002 ) . In addition , hemoglobin A1c levels were significantly reduced in the intervention group compared with the control group ( −1.57 % ± 1.50 % vs –0.40 % ± 1.19 % , P < .001 ) ; a similar profile was seen with low-density lipoprotein cholesterol ( −0.36 ± 0.76 vs −0.03 ± 0.74 , P = .026 ) . Furthermore , there were nonsignificant improvements in high-density lipoprotein cholesterol , triglyceride , and blood pressure in the intervention group . The increased level of underst and ing regarding medications in the intervention group was statistically significant ( P < .001 ) , yielding a better enhancement in compliance compared with patients in the control group ( 22.5 % ± 13.4 % vs 2.0 % ± 5.0 % , P < .001 ) . Conclusion : The pharmacist care program implemented in this study demonstrated a significant cardiovascular risk reduction in type 2 diabetic patients ; therefore such a program would be a valuable addition to a multidisciplinary care of diabetic patients Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more OBJECTIVE —The effectiveness of intentional weight loss in reducing cardiovascular disease ( CVD ) events in type 2 diabetes is unknown . This report describes 1-year changes in CVD risk factors in a trial design ed to examine the long-term effects of an intensive lifestyle intervention on the incidence of major CVD events . RESEARCH DESIGN AND METHODS —This study consisted of a multicentered , r and omized , controlled trial of 5,145 individuals with type 2 diabetes , aged 45–74 years , with BMI > 25 kg/m2 ( > 27 kg/m2 if taking insulin ) . An intensive lifestyle intervention ( ILI ) involving group and individual meetings to achieve and maintain weight loss through decreased caloric intake and increased physical activity was compared with a diabetes support and education ( DSE ) condition . RESULTS — Participants assigned to ILI lost an average 8.6 % of their initial weight vs. 0.7 % in DSE group ( P < 0.001 ) . Mean fitness increased in ILI by 20.9 vs. 5.8 % in DSE ( P < 0.001 ) . A greater proportion of ILI participants had reductions in diabetes , hypertension , and lipid-lowering medicines . Mean A1C dropped from 7.3 to 6.6 % in ILI ( P < 0.001 ) vs. from 7.3 to 7.2 % in DSE . Systolic and diastolic pressure , triglycerides , HDL cholesterol , and urine albumin-to-creatinine ratio improved significantly more in ILI than DSE participants ( all P < 0.01 ) . CONCLUSIONS —At 1 year , ILI result ed in clinical ly significant weight loss in people with type 2 diabetes . This was associated with improved diabetes control and CVD risk factors and reduced medicine use in ILI versus DSE . Continued intervention and follow-up will determine whether these changes are maintained and will reduce CVD risk Background Individual health education is considered to be essential in the overall care of patients with type 2 diabetes ( DM2 ) , although there is some uncertainty regarding its metabolic control benefits . There have been very few r and omized studies on the effects of individual education on normal care in DM2 patients with a control group , and none of these have assessed the long-term results . Therefore , this study aims to use this design to assess the effectiveness of the PRECEDE ( Predisposing , Reinforcing , Enabling , Causes in Educational Diagnosis , and Evaluation ) education model in the metabolic control and the reduction of cardiovascular risk factors , in patients with type 2 diabetes . Methods An open community effectiveness study was carried out in 8 urban community health centers in the North-East Madrid Urban Area ( Spain ) . Six hundred patients with DM2 were r and omized in two groups : PRECEDE or conventional model for health promotion education . The main outcome measures were glycated hemoglobin A1c , body mass index ( BMI ) , blood pressure , lipids and control criteria during the 2-year follow-up period . Results Glycated hemoglobin A1c and systolic blood pressure ( SBP ) levels decreased significantly in the PRECEDE group ( multivariate analysis of covariance , with baseline glycated hemoglobin A1c , SBP , and variables showing statistically significant differences between groups at baseline visits ) . The decrease levels in diastolic blood pressure ( DBP ) , triglycerides and LDL cholesterol were nonsignificant . PRECEDE increased compliance in all control criteria , except for LDL cholesterol . BMI did not change during the study in either of the two models analyzed . Conclusions PRECEDE health education model is a useful method in the overall treatment in patients with type 2 diabetes , which contributes to decrease glycated hemoglobin A1c and SBP levels and increase the compliance in all the control criteria , except for LDL cholesterol . Trial registration number Clinical Trials.gov BACKGROUND Lifestyle interventions produce short-term improvements in glycemia and cardiovascular disease ( CVD ) risk factors in individuals with type 2 diabetes mellitus , but no long-term data are available . We examined the effects of lifestyle intervention on changes in weight , fitness , and CVD risk factors during a 4-year study . METHODS The Look AHEAD ( Action for Health in Diabetes ) trial is a multicenter r and omized clinical trial comparing the effects of an intensive lifestyle intervention ( ILI ) and diabetes support and education ( DSE ; the control group ) on the incidence of major CVD events in 5145 overweight or obese individuals ( 59.5 % female ; mean age , 58.7 years ) with type 2 diabetes mellitus . More than 93 % of participants provided outcomes data at each annual assessment . RESULTS Averaged across 4 years , ILI participants had a greater percentage of weight loss than DSE participants ( -6.15 % vs -0.88 % ; P < .001 ) and greater improvements in treadmill fitness ( 12.74 % vs 1.96 % ; P < .001 ) , hemoglobin A(1c ) level ( -0.36 % vs -0.09 % ; P < .001 ) , systolic ( -5.33 vs -2.97 mm Hg ; P < .001 ) and diastolic ( -2.92 vs -2.48 mm Hg ; P = .01 ) blood pressure , and levels of high-density lipoprotein cholesterol ( 3.67 vs 1.97 mg/dL ; P < .001 ) and triglycerides ( -25.56 vs -19.75 mg/dL ; P < .001 ) . Reductions in low-density lipoprotein cholesterol levels were greater in DSE than ILI participants ( -11.27 vs -12.84 mg/dL ; P = .009 ) owing to greater use of medications to lower lipid levels in the DSE group . At 4 years , ILI participants maintained greater improvements than DSE participants in weight , fitness , hemoglobin A(1c ) levels , systolic blood pressure , and high-density lipoprotein cholesterol levels . CONCLUSIONS Intensive lifestyle intervention can produce sustained weight loss and improvements in fitness , glycemic control , and CVD risk factors in individuals with type 2 diabetes . Whether these differences in risk factors translate to reduction in CVD events will ultimately be addressed by the Look AHEAD trial . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00017953 OBJECTIVE To assess the impact of personalized exercise prescription on habitual physical activity and glycemic control in sedentary , insulin treated type 2 diabetes patients during a 2-y intervention period . RESEARCH DESIGN AND METHODS 74 patients were r and omized to the intervention ( n=38 ) or control ( n=36 ) group . The intervention group was stimulated to increase daily physical activity through regular , structured , and personalized exercise prescription by a physical therapist over the 2-y intervention period . RESULTS Physical activity levels at work or in leisure time were not modulated by the exercise prescription intervention . In accordance , no changes in body composition , glycemic control , medication use or risk factors for cardiovascular disease were observed . CONCLUSIONS Long-term behavioral intervention programs , providing individualized exercise prescription , are not sufficient to change sedentary behavior and /or improve glycemic control in insulin treated , type 2 diabetes patients AIMS To determine whether tighter cardiovascular risk factor control with structured education in individuals with type 2 diabetes ( T2DM ) and microalbuminuria benefits cardiovascular risk factors . METHODS Participants from a multiethnic population , recruited from primary care and specialist clinics were r and omised to intensive intervention with structured patient ( DESMOND model ) education ( n=94 ) or usual care by own health professional ( n=95 ) . PRIMARY OUTCOME change in HbA1c at 18months . SECONDARY OUTCOMES changes in blood pressure ( BP ) , cholesterol , albuminuria , proportion reaching risk factor targets , modelled cardiovascular risk scores . RESULTS Mean ( SD ) age and diabetes duration of participants were 61.5 ( 10.5 ) and 11.5 ( 9.3 ) years , respectively . At 18months , intensive intervention showed significant improvements in HbA1c ( 7.1(1.0 ) vs. 7.8(1.4)% , p<0.0001 ) , systolic BP ( 129(16 ) vs. 139(17 ) mmHg , p<0.0001 ) , diastolic BP ( 70(11 ) vs. 76(12 ) mmHg , p<0.001 ) , total cholesterol ( 3.7(0.8 ) vs. 4.1(0.9 ) mmol/l , p=0.001 ) . Moderate and severe hypoglycaemia was 11.2 vs. 29.0 % ; p=0.001 and 0 vs. 6.3 % ; p=0.07 , respectively . More intensive participants achieved ≥3 risk factor targets with greater reductions in cardiovascular risk scores . CONCLUSIONS Intensive intervention showed greater improvements in metabolic control and cardiovascular risk profile with lower rates of moderate and severe hypoglycaemia . Intensive glycaemic interventions should be underpinned by structured education promoting self-management in T2DM Abstract Aims /hypothesis . Metabolic control worsens progressively in Type II ( non-insulin-dependent ) diabetes mellitus despite intensified pharmacological treatment and lifestyle intervention , when these are implemented on a one-to-one basis . We compared traditional individual diabetes care with a model in which routine follow-up is managed by interactive group visits while individual consultations are reserved for emerging medical problems and yearly checks for complications . Methods . A r and omized controlled clinical trial of 56 patients with non-insulin-treated Type II diabetes managed by systemic group education and 56 control patients managed by individual consultations and education .  Results . Observation times were 51.2±2.1 months for group care and 51.2±1.8 for control subjects . Glycated haemoglobin increased in the control group but not in the group of patients ( p<0.001 ) , in whom BMI decreased ( p<0.001 ) and HDL-cholesterol increased ( p<0.001 ) . Quality of life , knowledge of diabetes and health behaviours improved with group care ( p<0.001 , all ) and worsened among the control patients ( p=0.004 to p<0.001 ) . Dosage of hypoglycaemic agents decreased ( p<0.001 ) and retinopathy progressed less ( p<0.009 ) among the group care patients than the control subjects . Diastolic blood pressure ( p<0.001 ) and relative cardiovascular risk ( p<0.05 ) decreased from baseline in group patients and control patients alike . Over the study period , group care required 196 min and 756.54 US $ per patient , compared with 150 min and 665.77 US $ for the control patients , result ing in an additional 2.12 US $ spent per point gained in the quality of life score . Conclusion /interpretation . Group care by systemic education is feasible in an ordinary diabetes clinic and cost-effective in preventing the deterioration of metabolic control and quality of life in Type II diabetes without increasing pharmacological treatment Background Diabetes mellitus ( DM ) and chronic inflammation are strongly related to increased cardiovascular risk . The purpose of this study was to evaluate whether an aerobic training programme would ameliorate inflammatory and anti-inflammatory markers in patients with type 2 DM . Design Interventional study . Methods A total of 60 overweight individuals with type 2 DM , but without vascular complications , were r and omly assigned to either a 6-month aerobic exercise training programme ( four times/week , 45 - 60 min/session ) , design ated as exercise group , or to the control group .  All participants were on an oral antidiabetic regimen and none was receiving lipid-lowering medications . Anthropometric parameters , cardiorespiratory fitness , glycaemic and lipid profiles , high sensitivity C-reactive protein ( hs CRP ) , adiponectin , interleukin (IL)-10 , IL-18 , tumour necrosis factor (TNF)-a , insulin , reciprocal index of homoeostasis model assessment ( HOMA-IR ) , body fat and blood pressure ( BP ) were measured at baseline and at the end of the study . Results In comparison with baseline and control group , exercise-treated patients improved glucose control , lipid profile , exercise capacity ( Vo2 peak ) and exhibited decreased insulin resistance and systolic BP considerably ( P < 0.05 ) . Plasma adiponectin , TNF-α and body weight changed slightly across treatment ( P > 0.05 ) , whereas diastolic BP and fat mass tended to decrease ( P = 0.071 and 0.061 , respectively ) . Exercise training  reduced hs CRP ( from 0.48 ± 0.16 to 0.29 ± 0.2 mg/dl ; P = 0.04 ) and IL-18 ( from 315.19 ± 122.76 to 203.77 ± 96.02 pg/ml ; P = 0.02 ) . Moreover , exercise  provided anti-inflammatory protection through IL-10 increment ( P = 0.039 ) and IL-18/IL-10 ratio downregulation ( P = 0.014 ) . In multiple regression analysis , alteration in IL-18 was independently correlated with hs CRP and Vo2 peak changes ( P < 0.05 ) . Conclusion Aerobic exercise training without significant weight loss improves metabolic profile and exerts anti-inflammatory effects in patients with type 2 DM . Eur J Cardiovasc Prev Rehabil 14 : 837 - 843 © 2007 The European Society of BACKGROUND This study aim ed to assess the efficacy of an intensive exercise intervention strategy in promoting physical activity ( PA ) and improving hemoglobin A(1c)(HbA(1c ) ) level and other modifiable cardiovascular risk factors in patients with type 2 diabetes mellitus ( T2DM ) . METHODS Of 691 eligible sedentary patients with T2DM and the metabolic syndrome , 606 were enrolled in 22 outpatient diabetes clinics across Italy and r and omized by center , age , and diabetes treatment to twice-a-week supervised aerobic and resistance training plus structured exercise counseling ( exercise group ) vs counseling alone ( control group )  for 12 months . End points included HbA(1c ) level ( primary ) and other cardiovascular risk factors and coronary heart disease risk scores ( secondary ) . RESULTS The mean ( SD ) volume of PA ( metabolic equivalent hours per week ) was significantly higher ( P < .001 ) in the exercise ( total PA [ nonsupervised conditioning PA + supervised PA ] , 20.0 [ 0.9 ] , and nonsupervised , 12.4 [ 7.4 ] ) vs control ( 10.0 [ 8.7 ] ) group . Compared with the control group , supervised exercise produced significant improvements ( mean difference [ 95 % confidence interval ] ) in physical fitness ; HbA(1c ) level ( -0.30 % [ -0.49 % to -0.10 % ] ; P < .001 ) ; systolic ( -4.2 mm Hg [ -6.9 to -1.6 mm Hg ] ; P = .002 ) and diastolic ( -1.7 mm Hg [ -3.3 to -1.1 mm Hg ] ; P = .03 ) blood pressure ; high-density lipoprotein ( 3.7 mg/dL [ 2.2 to 5.3 mg/dL ] ; P < .001 ) and low-density lipoprotein ( -9.6 mg/dL [ -15.9 to -3.3 mg/dL ] ; P = .003 ) cholesterol level ; waist circumference ( -3.6 cm [ -4.4 to -2.9 cm ] ; P < .001 ) ; body mass index ; insulin resistance ; inflammation ; and risk scores . These parameters improved only marginally in controls . CONCLUSIONS This exercise intervention strategy was effective in promoting PA and improving HbA(1c ) and cardiovascular risk profile . Conversely , counseling alone , though successful in achieving the currently recommended amount of activity , was of limited efficacy on cardiovascular risk factors , suggesting the need for a larger volume of PA in these high-risk subjects . Trial Registration is rct n.org Identifier : IS RCT N04252749 Objective To determine the extent to which intensive dietary intervention can influence glycaemic control and risk factors for cardiovascular disease in patients with type 2 diabetes who are hyperglycaemic despite optimised drug treatment . Design R and omised controlled trial . Setting Dunedin , New Zeal and . Participants 93 participants aged less than 70 years with type 2 diabetes and a glycated haemoglobin ( HbA1c ) of more than 7 % despite optimised drug treatments plus at least two of overweight or obesity , hypertension , and dyslipidaemia . Intervention Intensive individualised dietary advice ( according to the nutritional recommendations of the European Association for the Study of Diabetes ) for six months ; both the intervention and control participants continued with their usual medical surveillance . Main outcome measures HbA1c was the primary outcome . Secondary outcomes included measures of adiposity , blood pressure , and lipid profile . Results After adjustment for age , sex , and baseline measurements , the difference in HbA1c between the intervention and control groups at six months ( −0.4 % , 95 % confidence interval −0.7 % to −0.1 % ) was highly statistically significant ( P=0.007 ) , as were the decreases in weight ( −1.3 kg , −2.4 to −0.1 kg ; P=0.032 ) , body mass index ( −0.5 , −0.9 to −0.1 ; P=0.026 ) , and waist circumference ( −1.6 cm , −2.7 to −0.5 cm ; P=0.005 ) . A decrease in saturated fat ( −1.9 % total energy , −3.3 % to −0.6 % ; P=0.006 ) and an increase in protein ( 1.6 % total energy , 0.04 % to 3.1 % ; P=0.045 ) in the intervention group were the most striking differences in nutritional intake between the two groups . Conclusions Intensive dietary advice has the potential to appreciably improve glycaemic control and anthropometric measures in patients with type 2 diabetes and unsatisfactory HbA1c despite optimised hypoglycaemic drug treatment . Trial registration Clinical trials NCT00124553 OBJECTIVE To assess the effectiveness of a culturally sensitive , structured education programme ( CSSEP ) on biomedical , knowledge , attitude and practice measures among Arabs with type two diabetes . RESEARCH DESIGN S AND METHODS A total of 430 patients with type II diabetes mellitus living in Doha , Qatar were enrolled in the study . They were r and omized to either intervention ( n = 215 ) or a control group  ( n = 215 ) . A baseline and one-year interval levels of biomedical variables including HbA1C , lipid profile , urine for microalbuminuria ; in addition to knowledge , attitude and practice ( KAP ) scores were prospect ively measured . The intervention was based on theory of empowerment , health belief models and was culturally sensitive in relation to language ( Arabic ) , food habits and health beliefs . It consisted of four educational sessions for each group of patients ( 10 - 20 patients per session ) , lasting for 3 - 4 h. The first session discussed diabetes pathophysiology and complications ; while the second session discussed healthy life style incorporating the Idaho plate method ; and the third session dealt with exercise benefits and goal setting and the fourth session concentrated enhancing attitude and practice using counselling techniques . Outcomes were assessed at base line and 12 months after intervention . RESULTS After 12 months participation in the intervention was shown to have led to a statistically significant reduction in HbA1C in the ( CSSEP ) group ( -0.55 mmol/L , P = 0.012 ) , fasting blood sugar ( -0.92 mmol/L , P = 0.022 ) , body mass index ( 1.70 , P = 0.001 ) and albumin/creatinine ratio ( -3.09 , P < 0.0001 ) but not in the control group . The intervention group also had improvement in Diabetes knowledge ( 5.9 % , P < 0.0001 ) , attitude ( 6.56 % , P < 0.0001 ) , and practice ( 6.52 % , P = 0.0001 ) . CONCLUSION This study demonstrates the effectiveness of culturally sensitive , structured , group-based diabetes education in enhancing biomedical and behavioural outcomes in Diabetic patients
target: Results reveal no significant difference between the groups , with respect to BMI , while PA and DIET yielded a greater reduction in HbA1c .
  Significant reduction in both systolic and diastolic pressures in the DIET group , and diastolic pressure in the PA group , was observed .
  HDL-c in the DIET group was significantly higher than the control group , while no change in LDL-c levels , was seen in all three intervention subtypes .
  There was no difference between the EDU vs. the control group in terms of HbA1c , blood pressure or HDL-c and LDL-c .
  CONCLUSION DIET intervention showed an improvement in HbA1c , systolic/diastolic blood pressure and HDL-c , with an exception of LDL-c and BMI , suggesting that nutritional intervention had a significant impact on the quality of life by reducing the cardiovascular risk in type 2 diabetes patients
background: BACKGROUND The current meta- analysis evaluated the outcomes of various lifestyle interventions , including diet modifications ( DIET ) , physical activity ( PA ) , and patient education ( EDU ) in reducing the risk of cardiovascular disease in patients with type 2 diabetes .