A minority of published evidence -based PA interventions for adults with T2D were both effective and pragmatic for clinical implementation .
Although regular physical activity ( PA ) is a cornerstone of treatment for type 2 diabetes ( T2D ) , most adults with T2D are sedentary .
R and omized controlled trials ( RCTs ) have proven the effectiveness of PA behavioral interventions for adults with T2D but have rarely been conducted in healthcare setting s. We sought to identify PA interventions that are effective and practical to implement in clinical practice setting s. Our first aim was to use the valid Pragmatic-Explanatory Continuum Indicator Summary 2 ( PRECIS-2 ) tool to assess the potential for future implementation of PA interventions in clinical practice setting s. Our second aim was to identify interventions that effectively increased PA and glycemic control among the interventions in the top tertile of PRECIS-2 scores .
Effects of lifestyle education program for type 2 diabetes patients in clinics: a cluster randomized controlled trial
Background The prevalence of type 2 diabetes is rising worldwide , as has been the global mean fasting plasma glucose level . This study aim ed to evaluate the effectiveness of a structured individual-based lifestyle education ( SILE ) program to reduce the hemoglobin A1c ( HbA1c ) level in type 2 diabetes patients delivered by registered dietitians in primary care clinical setting s. Methods This was a 6-month prospect i ve cluster r and omized controlled trial in a primary care setting with r and omization at the practice level . Twenty general practitioners in 20 clinics in Kanagawa prefecture , Japan , were involved . 193 adults ( 51 % men , mean age 61.3 years ) with type 2 diabetes and HbA1c ≥6.5 % who received treatment in medical clinics were the participants .  A SILE program was implemented through 4 sessions with trained registered dietitians during the 6-month study period . Results were compared with those of a control group who received usual care . The primary endpoint was the change in HbA1c levels at 6 months from baseline . Secondary endpoints were the changes at 6 months from baseline in fasting plasma glucose , lipid profile , blood pressure , BMI , energy , and nutrient intakes ( whole day and each meal ) . Intention-to-treat analysis was conducted . Mixed-effects linear models were used to examine the effects of the treatment . Results The mean change at 6 months from baseline in HbA1c was a 0.7 % decrease in the intervention group ( n = 100 ) and a 0.2 % decrease in the control group ( n = 93 ) ( difference −0.5 % , 95%CI : -0.2 % to −0.8 % , p = 0.004 ) . After adjusting for baseline values and other factors , the difference was still significant ( p = 0.003 ~ 0.011 ) . The intervention group had a significantly greater decrease in mean energy intake at dinner compared with the control group and a greater increase in mean vegetable intake for the whole day , breakfast , and lunch as shown in crude and adjusted models . A tendency toward improvement was observed in the other secondary endpoints but the improvement was not statistically significant . These results were confirmed by several sensitivity analyses . Conclusions The SILE program that was provided in primary care setting s for patients with type 2 diabetes result ed in greater improvement in HbA1c levels than usual diabetes care and education . Trial registration
A minority of published evidence -based PA interventions for adults with T2D were both effective and pragmatic for clinical implementation .
Although regular physical activity ( PA ) is a cornerstone of treatment for type 2 diabetes ( T2D ) , most adults with T2D are sedentary .
R and omized controlled trials ( RCTs ) have proven the effectiveness of PA behavioral interventions for adults with T2D but have rarely been conducted in healthcare setting s. We sought to identify PA interventions that are effective and practical to implement in clinical practice setting s. Our first aim was to use the valid Pragmatic-Explanatory Continuum Indicator Summary 2 ( PRECIS-2 ) tool to assess the potential for future implementation of PA interventions in clinical practice setting s. Our second aim was to identify interventions that effectively increased PA and glycemic control among the interventions in the top tertile of PRECIS-2 scores .