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According to one of the largest studies of its kind, people with diabetes are less likely to lose weight over a 1-year period if they believe that their inability to lose weight is due to an endocrine disorder. They are also less likely to lose weight if they believe that the inability is due to their own eating and exercise behavior.
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Those are among the early unexpected and conflicting results from the Study to Help Improve Early evaluation and management of risk factors Leading to Diabetes (SHIELD), a 5-year nationwide observational survey, reported at the 33rd Annual Meeting and Exhibition of the American Association of Diabetes Educators (AADE), held August 9–12 in Los Angeles.
"This was a study in which the results really weren't what we expected," says SHIELD researcher Andrew Green, MD, an endocrinologist at Midwestern Endocrinology in Overland Park, Kan.
The results "don't fit neatly into a paradigm," Green says. "It confirms for me the clinical impression I've had from practicing for 20 years, which is that we don't have a clue about how to make people lose weight."
Underwritten by AstraZeneca, SHIELD began in 2004 with a 12-item screening survey mailed to 200,000 households. A more indepth survey was completed in 2005 by 11,671 adults with diabetes and varying degrees of metabolic risk. The survey will be repeated annually until 2010.
Based on the initial screening survey, the first results reveal that of the respondents with diabetes, 56% were obese, 59.5% had hypertension, and 57.1% had dyslipidemia. "Alarming rates" of people reported combinations of risk factors, with almost one-quarter of respondents reporting having all three risk factors. Walter Stewart, MD, and colleagues of Geisinger Medical Center reported these results in May at an American Heart Association conference on quality of care and outcomes research, held in Washington, D.C.
The 2005 survey looked more closely at health behaviors, producing results that left researchers scratching their heads. About half of the SHIELD participants reported losing weight in the previous 1-year period.
According to data presented at AADE, respondents were less likely to have a reduction in weight or waist size if they reported exercising more regularly or more vigorously, having a better health status, and expecting their health to improve in the next year.
"We were troubled, [but] when you do a study, you report the results," Green says. "We used well-validated tools, and this is what we got. In some ways this was an unsatisfying study, because it didn't confirm the conventional wisdom that we expected. But that's the nature of research."
Another aspect of SHIELD reported at AADE looked at depression among people at risk of developing diabetes. The results surprisingly suggest that receiving the diagnosis of type 2 diabetes did not raise the risk of depression. Researchers found that the proportion of respondents with moderate to severe depression actually decreased from baseline to the 2005 survey.
Along with the findings related to beliefs, the SHIELD results so far suggest that many preconceived notions that health professionals have about people at risk of obesity and diabetes may be unfounded.
"What this study illustrates is how difficult it is to come up with answers that conform to our current level of practice and the conventional wisdom about how to help people do better," Green says. "This is sheer speculation, but it may be that people's beliefs and their behaviors don't correlate as much as we expect them to."
New Tools
The American Association of Diabetes Educators (AADE) recently unveiled a Web-based resource to help providers better manage patients with diabetes and obesity.
AADE7 Impact is a suite of tools that allow providers to track patient behavior-change goals and clinical measures, communicate more effectively with patients and their physicians, and run reports on individual patients or an entire patient population.
The software was developed by AADE in partnership with the University of Pittsburgh Diabetes Institute.
AADE7 Impact includes printable goal sheets, letter-writing templates, a document center with references and resources for patient education, and reporting functions.
The software is available free to association members. For more information, visit www.aadenet.org/AADE7 or contact AADE at 800-338-3633.
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| DOC News | Diabetes | Diabetes Care | Clinical Diabetes | Diabetes Spectrum |
