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Achieving Meaningful, Long-Term Weight Loss

Achieving Meaningful, Long-Term Weight Loss

The Look AHEAD (Action for Health in Diabetes) study was an important analysis that assessed the long-term effects of an intensive lifestyle intervention (ILI) program designed to induce weight loss among 5,145 overweight volunteers with type 2 diabetes. Participants were randomly assigned to either the ILI program or usual care, referred to as diabetes support and education (DSE). The ILI program consisted of frequent group and individual counseling sessions led by dietitians, psychologists, or exercise specialists. DSE patients received a limited number of group sessions that provided support and education. Long-Term Data In a study published in Obesity, Thomas A. Wadden, PhD, and colleagues evaluated the 8-year weight loss achieved with the ILI in Look AHEAD. ILI patients lost 8.6% of their initial weight, on average, at 1 year and 4.7% of their initial weight at 8 years. DSE recipients lost only 0.6% of their initial weight at 1 year and 2.1% at 8 years. “Results for the ILI are superior to most past studies in which participants typically regained all of their lost weight in 3 to 5 years,” says Dr. Wadden. At 1 year, more than two-thirds of patients who received the ILI lost at least 5% of their initial body weight, a measure of clinically meaningful weight loss, compared with about 13% of those receiving DSE. At 8 years, these percentages were about 50% for the ILI group and 36% for DSE. Importantly, about one-third of patients in the ILI group lost at least 10% of their initial weight at 1 year, and nearly 40% of these people maintained this weight loss when assessed at 8...
Initiating Insulin: Strategies to Overcome Patient Fears

Initiating Insulin: Strategies to Overcome Patient Fears

This Physician’s Weekly feature on initiating insulin and strategies to overcome patient fears was completed in cooperation with the experts at the American Diabetes Association. Many patients with type 2 diabetes eventually require insulin therapy and benefit from it. Timely initiation of insulin is critical to managing diabetes and helping patients avoid disease-related complications. “Insulin is an effective treatment for diabetes, but patients and physicians alike often consider this therapy a last resort. This can lead to long delays in patients starting insulin, which in turn lead to longer periods of elevated blood sugars that place these individuals at higher risk for complications,” says Jeremy Pettus, MD. “The reasons why patients are hesitant to take insulin are multifactorial. Providers need to understand the barriers to insulin initiation and reduce any negative perceptions that patients may have about taking this important medication.” Considering Patient Barriers Many patients have misconceptions on what it means to be prescribed insulin, according to Dr. Pettus. Some patients see insulin as potentially leading to more health problems down the road. Others perceive it as a punishment if they fail to do what is necessary to properly manage their diabetes. Clinicians should get an understanding of patients’ views on insulin before they initiate it. “We should inform patients about the progressive nature of the disease that commonly results in requiring insulin and objectively explain to them why insulin is required,” Dr. Pettus says. “These conversations should happen early after a diabetes diagnosis and be framed in a way that leaves open the possibility that insulin may be necessary later in the course of the disease. In...
Ebola: Are We Prepared?

Ebola: Are We Prepared?

While the government came out last week proclaiming that healthcare workers are prepared for an Enola outbreak, the majority of us do not feel this is the case. Virtually no one in the US has seen, or treated, a case of Ebola virus in the past. Now, not only are we expected to recognize patients that may be infected with this deadly virus, we need to be prepared to prevent the spread of this highly contagious pathogen if we were to encounter it. The CDC has done an excellent job passing its guidelines to ER’s and local health departments across the nation. But, these simply have not trickled down to those of us on the front lines: doctors and healthcare workers in outpatient settings, nurses, EMT’s paramedics, and all those who may be the first to encounter an Ebola patient. This represents a very significant gap in the system. There is no one to blame for this gap. Everyone is working hard to get a handle on it, but it simply is an enemy we have never seen before and are forced to develop guidelines for it as we are under attack. The CDC advises that if you have a suspect patient in your practice, place him/her in an exam room, close the door, and contact the local health department. I work evening hours. The health department closes at 5PM. I cannot keep my patient locked in the exam room until they open up again in the morning. Of course, a breach of the suggested protocols will have to be made to get this patient to the emergency room where...
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