Title: ACTID Follow up: A 3 year follow up of patients who took part in the Early ACTID study
Funder: Department of Health (England)

Abstract: Background The NSF for Diabetes states that patients should receive ’help in adopting and maintaining a healthy lifestyle’. As a result of this, a number of education programs have been set up for patients with type 2 diabetes (T2DM). Although there is some evidence to suggest that in the short term these programs improve diabetes control, there is no evidence as to whether they work in the medium to longer term. We have shown that providing patients with newly diagnosed T2DM with a program that teaches them to either improve their diet or improve both diet and activity levels over 12 months leads to better weight loss and diabetes control than in those who were given usual care. We now need to know whether these skills will continue to be used and whether the benefits continue for the longer term. Aims We aim to find out what happens over the following 5 years to patients involved in the Early ACTID trial. This will enable us to determine: 1. The size of any beneficial effect of a diet and a diet & activity program on weight, glycaemic control, blood pressure, lipid profiles and the natural history of T2DM as indicated by insulin resistance and medication use, above that produced by usual care in newly diagnosed patients with T2DM at 1, 2, 3, 4 and 5 yrs after completion of this program. 2.Whether these programs improve eating patterns, activity habits and well being above that produced by usual care, 1, 2, 3, 4 and 5 yrs after completion of this program. 3.Whether if ongoing benefits are seen, these are greater for those in the diet & activity compared to the diet alone program. Plan of Investigation All patients who completed the Early ACTID study will be invited to participate. Those that agree will attend a 3 hour yearly visit to have the measures listed below. These visits will occur at 1, 2, 3, 4 and 5 years after they left the study. History, current medication and history of recent illness. Clinical measures: blood pressure, weight, height, waist and hip circumference, percentage lean and fat body content Blood analysis: HbA1c & fasting glucose; Total, HDL and LDL cholesterol, triglycerides; Insulin resistance- calculated by the Homeostatic model method. Physical activity: assessed using an accelerometer worn for 7 days. Well being: Diener’s satisfaction with life, Rosenberg self-esteem, EQ5D. Diet: 4 day food diary together with 45 min interview with a dietitian Potential Impact Early ACTID participants received a straightforward behavioural based program early on in their patient journey which reduced weight and insulin resistance, improved glycaemic control, and resulted in less medication use. These programs were nurse led and after modification and staff training could easily be implemented in primary care. Knowing if benefits from these programs continue to work in the long term is of paramount importance for planning future diabetes services, as it will help to determine whether courses need to be continued or whether refresher courses can just be given at certain time intervals. Maintenance of lifestyle changes, even for 1-2 years, may result in significant savings on medication as well as reductions in cardiovascular risk and diabetes complications.


Research activity codes: 6.7 PHYSICAL
Health categories: METABOLIC AND ENDOCRINE