BEHAVIOR-MODIFICATION IN OBESE SUBJECTS WITH TYPE-2 DIABETES-MELLITUS

We have followed prospectively, 46 obese, type 2 diabetic patients for a 55-week period, in order to evaluate the efficiency of an educational programme based on behaviour modification to enhance weight loss and changes of other cardiovascular risk factors. No patient received pharmacological treatment during the study. At the end of the follow-up the patients obtained an average weight loss of 9.250 kg (range: 0.500-17.500 kg); the BMI was reduced from 34.2 +/- 0.8 kg/m2 to 30.6 +/- 1.1 kg/m2 (P < 0.01); fasting serum glucose descended from 7.9 +/- 0.4 to 6.1 +/- 0.5 mM (P < 0.05); SBP (systolic blood pressure) decreased from 145.7 +/- 3 to 126.4 +/- 5.1 mmHg (P < 0.01); DBP (diastolic blood pressure) decreased from 83.5 +/- 2.5 to 65 +/- 2.6 mmHg (P < 0.01); triglyceride levels were lowered from 164.5 +/- 12 to 109.7 +/- 10 mg/dl (P < 0.01); HDL-cholesterol levels increased from 1.27 +/- 0.05 to 1.53 +/- 0.12 mM (P < 0.01). Serum glucose 2 h after a 75 g glucose oral load glucose oral decreased from 14.9 +/- 0.6 to 12.7 +/- 0.9 mM (P < 0.05) on week 35 of follow-up. Twelve patients no longer presented a diabetic curve (8 normal oral glucose tolerance test (OGTT) curves, and 4 impaired glucose tolerance (IGT) curves). No significant changes in the parameters studied were obtained in the group of patients on conventional treatment. Patients from the intervention group losing less than 4 kg of body weight displayed an increase in dependence and social introversion scores according to the Minnesota multiphasic personality inventory (MMPI) compared to those who lost more than 4 kg (possibly as a consequence of failure to attain the aims of the educational programme). Our results permit us to conclude that an educational programme using behaviour modification can be useful in the weight reduction of obese type 2 diabetic patients, thereby improving blood glucose control and reducing other cardiovascular risk factors.