Developing an Adaptive Lifestyle Intervention Program in Family Medicine Clinics
Condition: Insulin Resistance; Obesity; Diabetes; Hypertension; Dyslipidemias; Metabolic Syndrome
MeSH terms: Metabolic Syndrome; Insulin Resistance; Dyslipidemias
Study type: Interventional

Summary: 
      The purpose of this study is to investigate the feasibility of conducting a multicomponent
      lifestyle intervention research study within the UAB Family Medicine Clinic at Highlands and
      to obtain preliminary data on the effectiveness of the adaptive treatment strategies being
      investigated to produce improvements in insulin resistance. This study is a Sequential
      Multiple Assignment Randomized Trial (SMART) with initial randomization groups of
      individualized nutrition counseling vs. individualized exercise counseling. Note that these
      initial nutrition or exercise interventions are NOT intended to produce significant weight
      loss. Participants that do not sufficiently improve their insulin resistance score after 8
      weeks will be re-randomized to 2nd stage interventions of either receiving dietary counseling
      for weight loss or receiving a prescription for metformin. We will collect data on the
      effectiveness of the intervention to improve insulin resistance/metabolic health in the
      family medicine clinic as well as potential predictors or moderators of treatment success.
    


Intervention name(s): Diet Counseling; Exercise Counseling
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Delivery of nutrition counseling intervention to improve diet quality. Suggested energy intake will be prescribed with the intent to maintain energy balance and current body weight. A total of 16 nutrition counseling sessions lasting ~30 minutes will be scheduled with a frequency of 1 session per week for 1 month (5 sessions), 1 session every-other week for months 2-6 (11 sessions). "Responding" participants who have improved their insulin resistance as measured at the 8-week visit will continue receiving this level of nutrition counseling through the end of the study, meeting with the dietitian every other week. Starting at week 9, those identified as "non-responding" participants will be re-randomized to 2nd stage interventions, of either receiving nutrition counseling for weight loss (meeting with the dietitian every other week) or the addition of a prescription for metformin.; Delivery of exercise counseling intervention to increase engagement in physical activity. The exercise specialist will counsel participants to progressively increase their weekly physical activity. Weight loss is not a primary goal of these exercise counseling sessions. A total of 16 exercise counseling sessions lasting ~30 minutes will be scheduled with a frequency of 1 session per week for 1 month (5 sessions), 1 session every-other week for months 2-6 (11 sessions). "Responding" participants who have improved their insulin resistance as measured at the 8-week visit will continue receiving this level of exercise counseling through the end of the study, meeting with the exercise specialist every other week. Starting at week 9, those identified as "non-responders" will be re-randomized to 2nd stage interventions, of either receiving nutrition counseling for weight loss (meeting with the dietitian every other week) or the addition of a prescription for metformin.
Allocation: Randomized
Intervention model: Sequential Assignment
Intervention model description: Sequential Multiple Assignment Randomized Trial (SMART)
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: insulin resistance