A Telephone Based Diabetes Prevention Program and Social Support for Weight Loss The Call 2 Health Study FULLER

587 views

Published on

Behavior Change Interventions

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
587
On SlideShare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
8
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

A Telephone Based Diabetes Prevention Program and Social Support for Weight Loss The Call 2 Health Study FULLER

  1. 1. A Telephone-BasedDiabetes Prevention Programand Social Support for Weight Loss:the Call-2-Health Study Presenter: Sharon Fuller Co-authors: Evette Ludman, PhD; Amy Mohelnitzky MEd; Gabrielle Gundersen; Rob Wellman, MS; Rob Reid, MD, PhD; Katherine Newton, PhD HMORN 2012 Conference May 2, 2012 Funded by NIDDK R34 DK076555
  2. 2. Call-2-HealthDiabetes Prevention Program (DPP) translation Goal to design an intervention that:  Is effective in diverse populations and settings  Is affordable  Has reach 2-year pilot study (R34 - NIDDK)  Randomized controlled trial  Effect on weight loss and exercise of telephonic behavioral intervention modeled on the DPP vs. usual care
  3. 3. Main Study Aims1. Evaluate feasibility / acceptability2. Conduct a preliminary evaluation of the intervention’s effectiveness3. Inform the design and implementation of a full- scale effectiveness trial
  4. 4. Sub-Analysis AimsOn the hypothesis that social support may be critical tolong-term maintenance of behavioral changes, we: assessed the impact of Call-2-Health on participants’ report of support for dietary changes from family and friends examined the correlation of social support for dietary changes with weight loss success
  5. 5. Inclusion Criteria From automated records  Male or female  Age 45-74  BMI ≥ 25 kg/m2  Fasting plasma glucose 105-125 mg/dl or A1C 5.7-6.4  Receives primary care at Group Health’s Central, Rainier, or Poulsbo Clinic Followed up with phone screening and laboratory tests to confirm eligibility and willingness to participate
  6. 6. Exclusion Criteria Medical History  Type 1 or 2 diabetes  FPG <105 or >125 mg/dl at screening blood draw  HbA1C <5.7 or >6.4 at screening blood draw  Exercise ≥ 30 minutes/day, at least five days a week  Current participation in another structured weight loss program or intervention study  Severe concurrent disease  Unable to walk ≥ 10 minutes Logistics  Unavailable for the 24-week study period  Unable to read or speak English
  7. 7. InterventionParticipants randomly assigned to usual care (UC) and intervention groups (IG) for the 24-week study Usual Care (n=23)  Clinic visits at baseline, 12 and 24 weeks, including physical measures, blood tests and collection of questionnaires  Three UC participants failed to complete the study Intervention Group (n=24)  Usual Care plus 12 weekly intervention calls and 4 maintenance calls over the following 12 weeks  IG participants completed 95% of intervention calls
  8. 8. Sallis Social Support Scale – Eating Habits Separate measures of encouraging and discouraging behaviors by family and friends Five questions per measure Answers “none” (1) to “very often” (5) based on behaviors in the last three months Scored by totaling points (possible range 5-25 points)
  9. 9. Social Support for Eating Habits - ItemsEncouragement Discouragement Encouraged me not to eat  Ate high fat or high calorie foods “unhealthy food” (cake, potato in front of me chips) when I am tempted to do  Refused to eat the same foods I so eat Discussed my eating habit  Brought foods I am trying not to changes with me (asked me how eat I am doing with my eating  Got angry when I encouraged changes) them to eat low calorie, low fat Reminded me not to eat high fat, foods high calorie foods  Offered me food I am trying not to Complimented me on changing eat my eating habits (“Keep it up”, “We are proud of you”) Commented if I went back to my old eating habits
  10. 10. Results
  11. 11. Recruitment Mailings (n=438) (Male = 228, Female = 210) Ineligible (n=200) Refusal (n=191) Randomized (n=47) (stratified by clinic and sex) Usual Care Intervention (n=23) (n=24) Lost to follow-up (n=2) Withdrew (n=1)
  12. 12. Participant Characteristics at Baseline Usual Care (n=23) Intervention (n=24)Age, mean (SD) 56.9 (8.2) 59.7 (8.3)Female, % 52% 50.0%Married or cohabiting, % 77.3% 70.8%Hispanic, % 0% 8.3%Race, % White 72.7% 83.3% Black 22.7% 12.5% Asian 4.6% 0.0% Other 0.0% 4.2%Weight, mean (SD) (Kg) 90.5 (21.9) 101.9 (21.8)BMI, mean (SD) (Kg/M2) 31.4 (5.3) 35.0 (7.2)FPG, mean (SD) (mg/dL) 105.3 (7.7) 106.8 (8.9)HbA1C, mean (SD) (%) 5.8 (0.3) 5.8 (0.3)
  13. 13. Participant Characteristics at BaselineSallis Eating HabitsSocial Support Scores,mean (SD) Usual Care InterventionEncouragement Family 12.1 (6.5) 12.1 (5.8) Friends 8.6 (4.8) 6.7 (2.3)Discouragement Family 11.0 (4.8) 9.1 (4.2) Friends 9.6 (4.0) 10.7 (4.7)
  14. 14. Outcomes – Weight Loss Usual Care Intervention Difference 24 Weeks n=21 n=23 p Mean (95% CI) Mean (95% CI) Mean (95% CI)Weight (Kg) 94.9 88.0 -6.9 <.0001 (92.8, 96.9) (85.3, 90.6) (-10.2, 3.5)BMI (Kg/M2) 32.7 30.3 -2.4 <.0001 (32.0, 33.4) (29.4, 31.2) (-3.5, -1.3)Achieved 7% 15.6 65.9 50.3 <.0001Weight Loss (%) (-12.8, 43.9) (28.4, 103.3) (25.7, 74.8)adjusted for baseline weight
  15. 15. Outcomes – Eating Habits Social Support Usual Care Intervention 24 Weeks p Mean (95% CI) Mean (95% CI)Encouragement Family 12.7 16.5 .013 (10.8, 14.6) (14.4, 18.6) Friends 7.8 10.6 .004 (6.5 ,9.2) (9.2,12.0)Discouragement Family 9.6 10.0 .672 (7.8,11.3) (9.1,11.0) Friends 9.4 9.9 .575 (7.7,11.0) (8.8,11.0)adjusted for baseline weight, age and baseline score
  16. 16. Correlation between weight loss and change in dietary encouragement - family 24 Weeks UCchange in weight (Kg) IG change in encouragement score UC: r = -0.69 (CI= -0.88, -0.28) IG: r = -0.56 (CI= -0.80, -0.12)
  17. 17. Correlation between weight loss and change in dietary encouragement - friends 24 Weeks UCchange in weight (Kg) IG change in encouragement score UC: r = -0.34 (CI = -0.68, 0.13) IG: r = -0.40 (CI = -0.71, 0.04)
  18. 18. Correlation between weight loss and change in dietary discouragement - family 24 Weeks UCchange in weight (Kg) IG change in discouragement score UC: r = -0.28 (CI= -0.68, 0.25) IG: r = -0.25 (CI= -0.63, 0.24)
  19. 19. Correlation between weight loss and change in dietary discouragement - friends 24 Weeks UCchange in weight (Kg) IG change in discouragement score UC: r = -0.41 (CI= -0.72, 0.05) IG: r = -0.56 (CI= -0.79, -0.16)
  20. 20. Discussion correlation <> causality  logical to hypothesize that increased encouragement facilitates weight loss  also logical to hypothesize that weight loss triggers discouragement from friends  haven’t proven either one wide variability in score changes; sometimes changes larger in UC than IG possible changes in perception or in participant rather than actual changes in support – particularly in IG small N means less power to detect differences
  21. 21. Conclusion The intervention did not specifically target increasing social support, but made a bigger difference in support scores than expected. Consistent with the literature, we found very high correlation between weight loss and increase in perceived social support for dietary changes, though the question of causality remains open.
  22. 22. Future Research DirectionsUsing existing data: compare increase in pedometer steps with changes in social support for exercise explore results of other weight-loss specific measuresAdditional research: larger N longer follow-up – once out of intensive weight loss phase and into maintenance phase
  23. 23. Study Team Katherine Newton, PhD Principal Investigator Evette Ludman, PhD Co-Investigator Rob Reid, MD, PhD Co-Investigator David McCulloch, MD Co-Investigator Gabrielle Gundersen Project Manager Amy Mohelnitzky, MEd Interventionist Rob Wellman, MS Biostatistician Sharon Fuller Programmer Julie Reardon Research Specialist Alison Thigpen MPH Student Myrte Dikmans Master’s Student
  24. 24. Supplementary Slides
  25. 25. Correlation between encouragement and discouragement - friends 24 Weekschange in encouragement score IG UC Change in discouragement score change in discouragement score UC: r = -0.01 (CI= -0.44, 0.42) IG: r = 0.34 (CI= -0.13, 0.67)
  26. 26. Participant Characteristics at BaselineSallis Eating HabitsSocial SupportScores, mean (SD) Usual Care InterventionEncouragement Family 12.1 (6.5) 12.1 (5.8) Friends 8.6 (4.8) 6.7 (2.3)Discouragement Family 11.0 (4.8) 9.1 (4.2) Friends 9.6 (4.0) 10.7 (4.7)
  27. 27. Participant Characteristics at BaselineSallis Social SupportScores, mean (95% CI) Usual Care Intervention pFamily n=18 n=19Dietary Encouragement 12.11 (8.87,15.36) 12.05 (9.25,14.85) .98Dietary Discouragement 11.00 (8.64,13.36) 9.05 (7.03, 11.08) .19Exercise Participation 22.89 (17.85,27.93) 24.37 (19.10, 29.63) .67Friends n=22 n=22Dietary Encouragement 8.55 (6.43,10.66) 6.73 (5.70,7.75) .12 (n=23)Dietary Discouragement 9.59 (7.80, 11.38) 10.70 (8.66, 12.73) .40 (n=24)Exercise Participation 18.86 (14.83,22.90) 17.58 (13.96,21.21) .63
  28. 28. Change in Dietary Support

×