BMC Public Health 2009, 9:166 http://www.biomedcentral.com/1471-2458/9/166 Discussion This prospective, controlled and randomized open label study tests the hypothesis that a new multi-disciplinary group-based lifestyle intervention programme for T2DM patients in a primary health care setting results in better short- and long-term glycaemic outcomes than the tradi- tional best practice for individual lifestyle counselling in a diabetes outpatient clinic setting. The major difference between the two interventions is that the new rehabilita- tion programme includes a supervised exercise pro- gramme, whereas the control group receives advice regarding physical activity. The content and the principles of empowering patients are the same in the two interven- tions, but the education programme in the health care centre is group-based. The evidence of the beneficial effects of exercise on diabe- tes symptoms, physical fitness and quality of life in T2DM is strong [41], and previous group-based non-pharmaco- logical lifestyle studies show improvement in glycaemic control and weight loss compared to individual counsel- ling [9]. Most lifestyle intervention studies have been focused mainly on education, including advice on physi- cal activity and diet, or on exercise training and/or diet. Only a few randomized controlled trials have investigated interventions incorporating several elements of non-phar- macological treatment of T2DM including patient educa- tion, supervised exercise and dietary advice on a group- based level [42-45]. However, the number of patients, fol- low-up time and effects on glycaemic control were very heterogeneous in these studies. It is very important in T2DM management programmes to find ways to increase the impact of non-pharmacological treatment in T2DM patients. Our study may add further evidence to this. The lifestyle rehabilitation programme is multi-discipli- nary including group-based education, dietary advice and exercise, and it is not possible to extract the individual effects of each component. The interventions are non- pharmacological, but the patients are urged to continue their medication throughout the study since the clinical effects of a multi-pharmacological treatment on late dia- betic complications are highly significant [46]. Decisions on changes in medication are left to the discretion of the patients' physicians, who are not part of this study. Disease management programmes tailored to the Danish health care system are currently developed for T2DM and other chronic conditions. Provision of rehabilitation pro- grammes for T2DM patients in a community-based set- ting, and health care centres, are a possible future part of the organization of prevention and chronic care in pri- mary care, and it is therefore essential to provide evidence for the patient-related effects. The evidence generated from The Copenhagen Type 2 Diabetes Rehabilitation Project may be helpful in the decision making of provid- ers to choose the most suitable lifestyle programme for their T2DM patients. Competing interests The authors declare that they have no competing interests. Authors' contributions ESV drafted the manuscript. ESV, AF, HP, EB and MR par- ticipated in the design of the study and provided input into the main ideas of this paper. ESV, AF, HP, EB and MR obtained funding for the project. ESV, AF, HP, EB and MR read, commented, and approved the final version of the manuscript. Acknowledgements The general practitioners Steen Frobenius and Thomas Saxild are involved in the planning of the study and of the recruitment of patients. The Diabetes working-group for the Project on Integrated Healthcare and Chronic Con- ditions contributes to the development of the clinical guidelines on exercise and diet instructions for type 2 diabetes patients and of the rehabilitation programme in the health care centre. The study is supported by grants from the Jascha Foundation, the Research Foundation of Bispebjerg Hospital, the Copenhagen Capital Region Research Foundation, National Board of Health, the Ministry of Health and Prevention, GlaxoSmithKline, Servier Denmark, Department of Endo- crinology at Bispebjerg University Hospital. References 1. Tuomilehto J, Lindstrom J, Eriksson JG, Valle TT, Hamalainen H, Ilanne-Parikka P, et al.: Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. 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