Patients with difficult-to-control diabetes who participated in weight management counseling during group medical visits experienced benefits beyond reduced blood-sugar levels, according to a study published in JAMA Internal Medicine in November 2019.

Directed by the Duke Diet and Fitness Center, the weight management counseling emphasized a low-carbohydrate diet, says lead study author William S. Yancy, Jr., MD, MHS, center director and a research associate at the Durham VA Medical Center. Following the group medical visits, the participants reported more weight loss, less use of diabetes medications, and fewer potentially dangerous episodes of lowered blood sugar levels compared to study participants who attended only group diabetes training.

The noninferiority randomized clinical trial was based on data from 263 individuals with uncontrolled diabetes and mean hemoglobin A_1c level of 9.1% at baseline. During the 48-week trial, the individuals’ hemoglobin A_1c level improved in both study groups (8.2% and 8.3%).

Half of the participants were randomly assigned to participate in group medical visits each month for four months to participate in diabetes control training. The other half were assigned to group medical visits with intensive diet coaching that promoted a low-carbohydrate regimen. This group met every two weeks for four months; after the first four months, both groups met every eight weeks until the study ended.

Initially, individuals participating in the diet intervention showed marked improvement in blood glucose levels compared to those in the other group, but by the end of the study, the differences evened out. Both interventions proved similarly helpful in lowering glucose levels.

However, the addition of weight management counseling provided extra health benefits, including weight loss and a 50% reduction in incidents of hypoglycemia. Diabetes medication use declined for participants in the weight management group while it increased in the other group.

Susan E. Spratt, MD, an endocrinologist who specializes in diabetes care, praised the results of the study and the collaboration between primary care and endocrinology.

“Group diabetes education has been in use for many years, but this approach is distinctive,” she says, adding that the counseling involves a physician or nurse practitioner, a facilitator, and a pharmacist.

“Intensive weight management using a low-carbohydrate diet can be as effective for glycemic improvement as medication intensification,” Yancy says. “We know that lifestyle changes can be difficult to maintain, but this study shows that group meetings can be an efficient and effective strategy that helps patients sustain these improvements.”