Current Diabetes Reports

, 8:413 | Cite as

The why WAIT program: Improving clinical outcomes through weight management in type 2 diabetes

Article

Abstract

Targeting body weight, as an alternative model to targeting hemoglobin A1c, is emerging as a viable and potentially cost-effective approach to diabetes management in clinical practice. Why WAIT (Weight Achievement and Intensive Treatment) is a 12-week multidisciplinary program for weight control and intensive diabetes management specifically designed for application in routine diabetes practice. The program, which is generally covered by insurance, is followed by continuous support aimed at long-term maintenance of weight loss and diabetes control. This model was effective in improving key metabolic abnormalities observed in diabetic patients. Eighty-two percent of participants achieved the target hemoglobin A1c of less than 7% on less diabetes medications. The achieved weight reduction after 12 weeks of intervention was maintained for an additional year. Future dissemination of this intervention model in routine clinical practice may require wider endorsement by third-party payers and support of governmental health care agencies to halt the progression of the epidemic of obesity and diabetes in the United States.

References and Recommended Reading

  1. 1.
    King H, Aubert RE, Herman WH: Global burden of diabetes, 1995–2025: prevalence, numerical estimates, and projections. Diabetes Care 1998, 21:1414–1431.PubMedCrossRefGoogle Scholar
  2. 2.
    Flegal KM, Carroll MD, Ogden CL, Johnson CL: Prevalence and trends in obesity among US adults, 1999–2000. JAMA 2002, 288:1723–1727.PubMedCrossRefGoogle Scholar
  3. 3.
    Lin SX, Pi-Sunyer EX: Prevalence of the metabolic syndrome among US middle-aged and older adults with and without diabetes—a preliminary analysis of the NHANES 1999–2002 data. Ethn Dis 2007, 17:35–39.PubMedGoogle Scholar
  4. 4.
    Turner RC, Cull CA, Frighi V, Holman RR: Glycemic control with diet, sulfonylurea, metformin, or insulin in patients with type 2 diabetes mellitus: progressive requirement for multiple therapies (UKPDS 49). UK Prospective Diabetes Study (UKPDS) Group. JAMA 1999, 281:2005–2012PubMedCrossRefGoogle Scholar
  5. 5.
    Henry RR, Gumbiner B, Ditzler T, et al.: Intensive conventional insulin therapy for type II diabetes. Metabolic effects during a 6-mo outpatient trial. Diabetes Care 1993, 16:21–31PubMedCrossRefGoogle Scholar
  6. 6.
    Hamdy O, Ledbury S, Mullooly C, et al.: Lifestyle modification improves endothelial function in obese subjects with the insulin resistance syndrome. Diabetes Care 2003, 26:2119–2125.PubMedCrossRefGoogle Scholar
  7. 7.
    Monzillo LU, Hamdy O, Horton ES, et al.: Effect of lifestyle modification on adipokine levels in obese subjects with insulin resistance. Obes Res 2003, 11:1048–1054.PubMedCrossRefGoogle Scholar
  8. 8.
    Pi-Sunyer X, Blackburn G, Brancati FL, et al.: Reduction in weight and cardiovascular disease risk factors in individuals with type 2 diabetes: one-year results of the look AHEAD trial. Diabetes Care. 2007, 30:1374–1383.PubMedCrossRefGoogle Scholar
  9. 9.
    Price JH, Desmond SM, Krol RA, et al.: Family practice physicians’ beliefs, attitudes, and practices regarding obesity. Am J Prev Med 1987, 3:339–345.PubMedGoogle Scholar
  10. 10.
    Hill JO, Wyatt H: Outpatient management of obesity: a primary care perspective. Obes Res 2002, 10(Suppl 2):124S–130S.PubMedCrossRefGoogle Scholar
  11. 11.
    Becker RH, Frick AD: Clinical pharmacokinetics and pharmacodynamics of insulin glulisine. Clin Pharmacokinet 2008, 47:7–20.PubMedCrossRefGoogle Scholar
  12. 12.
    Dornhorst A, Lüddeke HJ, Sreenan S, et al.: Insulin detemir improves glycaemic control without weight gain in insulinnaïve patients with type 2 diabetes: subgroup analysis from the PREDICTIVE study. Int J Clin Pract 2008, 62:659–665.PubMedCrossRefGoogle Scholar
  13. 13.
    Rosenstock J, Davies M, Home PD, et al.: A randomised, 52-week, treat-to-target trial comparing insulin detemir with insulin glargine when administered as add-on to glucose-lowering drugs in insulin-naive people with type 2 diabetes. Diabetologia 2008, 51:408–416.PubMedCrossRefGoogle Scholar
  14. 14.
    Giusti J, Rizzotto JA: Interpreting the Joslin Diabetes Center and Joslin Clinic Clinical Nutrition Guideline for Overweight and Obese Adults With Type 2 Diabetes. Curr Diab Rep 2006, 6:405–408.PubMedCrossRefGoogle Scholar
  15. 15.
    Campbell A: Tackling “diabesity” head-on. Joslin Diabetes Center’s new nutrition guideline. Diabetes Self Manag 2005, 22:40, 42–44.PubMedGoogle Scholar
  16. 16.
    Fenicchia LM, Kanaley JA, Azevedo JL Jr, et al.: Influence of resistance exercise training on glucose control in women with type 2 diabetes. Metabolism 2004, 53:284–289.PubMedCrossRefGoogle Scholar
  17. 17.
    Cuff DJ, Meneilly GS, Martin A, et al.: Effective exercise modality to reduce insulin resistance in women with type 2 diabetes. Diabetes Care 2003, 26:2977–2982.PubMedCrossRefGoogle Scholar
  18. 18.
    Daly RM, Dunstan DW, Owen N, et al.: Does high-intensity resistance training maintain bone mass during moderate weight loss in older overweight adults with type 2 diabetes? Osteoporos Int 2005, 16:1703–1712.PubMedCrossRefGoogle Scholar
  19. 19.
    Knowler WC, Barrett-Connor E, Fowler SE, et al.: Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002, 346:393–403.PubMedCrossRefGoogle Scholar
  20. 20.
    Wadden TA, Osei S: The treatment of obesity: an overview. In Handbook of Obesity Treatment. Edited by Wadden TA, Stunkard AJ. New York, NY: Guildford Press; 2002:229–248.Google Scholar
  21. 21.
    Hickman IJ, Jonsson JR, Prins JB, et al.: Modest weight loss and physical activity in overweight patients with chronic liver disease results in sustained improvements in alanine aminotransferase, fasting insulin, and quality of life. Gut 2004, 53:413–419.PubMedCrossRefGoogle Scholar
  22. 22.
    Dixon JB, Bhathal PS, O’Brien PE: Weight loss and non-alcoholic fatty liver disease: falls in gamma-glutamyl transferase concentrations are associated with histologic improvement. Obes Surg 2006, 16:1278–1286.PubMedCrossRefGoogle Scholar
  23. 23.
    Hsieh CJ, Wang PW: Effectiveness of weight loss in the elderly with type 2 diabetes mellitus. J Endocrinol Invest 2005, 28:973–977.PubMedGoogle Scholar
  24. 24.
    Parker B, Noakes M, Luscombe N, Clifton P: Effect of a high-protein, high-monounsaturated fat weight loss diet on glycemic control and lipid levels in type 2 diabetes. Diabetes Care 2002, 25:425–430.PubMedCrossRefGoogle Scholar
  25. 25.
    Navarro-Diaz M, Serra A, Romero R, et al.: Effect of drastic weight loss after bariatric surgery on renal parameters in extremely obese patients: long-term follow-up. J Am Soc Nephrol 2006, 17(12 Suppl 3):S213–S217.PubMedCrossRefGoogle Scholar
  26. 26.
    Saiki A, Nagayama D, Ohhira M, et al.: Effect of weight loss using formula diet on renal function in obese patients with diabetic nephropathy. Int J Obes (Lond) 2005, 29:1115–1120.CrossRefGoogle Scholar
  27. 27.
    Skov AR, Toubro S, Bulow J, et al.: Changes in renal function during weight loss induced by high vs low-protein low-fat diets in overweight subjects. Int J Obes Relat Metab Disord 1999, 23:1170–1177.PubMedCrossRefGoogle Scholar
  28. 28.
    Gannon MC, Nuttall FQ: Control of blood glucose in type 2 diabetes without weight loss by modification of diet composition. Nutr Metab (Lond) 2006, 3:16.CrossRefGoogle Scholar
  29. 29.
    Brinkworth GD, Noakes M, Parker B, et al.: Long-term effects of advice to consume a high-protein, low-fat diet, rather than a conventional weight-loss diet, in obese adults with type 2 diabetes: one-year follow-up of a randomised trial. Diabetologia 2004, 47:1677–1686.PubMedCrossRefGoogle Scholar
  30. 30.
    Aucott L, Poobalan A, Smith WC, et al.: Weight loss in obese diabetic and non-diabetic individuals and long-term diabetes outcomes—a systematic review. Diabetes Obes Metab 2004, 6:85–94.PubMedCrossRefGoogle Scholar
  31. 31.
    Yu AP, Wu EQ, Birnbaum HG, et al.: Short-term economic impact of body weight change among patients with type 2 diabetes treated with antidiabetic agents: analysis using claims, laboratory, and medical record data. Curr Med Res Opin 2007, 23:2157–2169.PubMedCrossRefGoogle Scholar

Copyright information

© Current Medicine Group LLC 2008

Authors and Affiliations

  1. 1.Joslin Diabetes CenterBostonUSA

Personalised recommendations