OR12-4 Intensive Lifestyle Intervention in Older Adults with Diabetes Improves Glycemic Control, Body Composition, Physical Function, and Bone Quality

Program: Abstracts - Orals, Poster Previews, and Posters
Session: OR12-Fresh Thoughts on Diabetes Treatment
Friday, April 1, 2016: 11:45 AM-1:15 PM
Presentation Start Time: 12:30 PM
Room 210 (BCEC)
Alessandra Celli*1, Dean Blevin1, Yoan Barnouin1, Georgia Colleluori1, Reina Condevillamar Villareal2 and Dennis Tan Villareal2
1Baylor College of Medicine, 2Michael E. DeBakey VA Medical Center
Background: Type 2 diabetes (T2D) is highly prevalent in older adults due to increasing adiposity and physical inactivity with advancing age. In fact, obesity worsens the metabolic and physical complications of aging that impair quality of life. Although lifestyle intervention is the primary therapy for T2D, this treatment approach is controversial in older adults because of potential exacerbation of sarcopenia and frailty. Currently, there are no directly applicable clinical trial data of lifestyle intervention in older adults with T2D, with recommended treatment approaches primarily based on expert opinion rather than high-level evidence.  

Methods/design: We present preliminary results of an ongoing randomized controlled trial (RCT) designed to comprehensively examine the effect of a lifestyle intervention strategy (behavioral diet therapy for weight loss and exercise training) in older (age: 65-85 yrs.) overweight/obese (BMI ≥ 27 kg/m2) adults with T2D. Main outcomes for this RCT included changes in: a) glycemic metabolic control (HbA1c), b) body weight and body composition (lean body mass, fat mass and visceral fat mass using DXA), c) physical function (Physical Performance Test [PPT], aerobic capacity [VO2peak]), and d) bone mineral density (BMD) and bone quality (trabecular bone score, TBS).  Subjects were randomized to intensive lifestyle intervention (LI group) or healthy-lifestyle control (HL group) for 6 months.

Results: To date, 17 subjects (age: 70.2±3.8 yrs., BMI: 35.3±6.0 kg/m2, HbA1c: 7.3±1.2%) have been enrolled and 13 subjects (76.5%) have completed the interventions. There were no significant differences in age and baseline BMI and HbA1c between the LI (n=10) and HL (n=7) groups. After 6 months, HbA1c significantly improved in the LI group compared with HL (-0.7±0.2 vs 0.2±0.4%; p<0.001). Body weight tended to decrease in the LI relative to HL (-8.1±3.2 vs. -1.9±7.7 kg; p=0.08) associated with significant decreases in fat mass (-4.6±6.6 vs. -2.1±6.6 kg, p=0.02) and visceral fat mass (-0.2±0.2 vs 0.0±0.1 kg; p=0.04) but relative preservation of lean body mass (0.3±3.4 vs. 0.9±5.1 kg; p=0.80). In addition, PPT (3.3±1.6 vs. 1.2±6.5) and VO2peak (2.7±1.1 vs. 0.4±1.5) also significantly improved in LI compared to HL. Finally, although there were no significant changes in BMD, TBS significantly improved in the LI group but not in the HL group (0.09±0.0 vs -0.02; p=0.04).  

Conclusion: These preliminary findings suggest that an intensive lifestyle intervention is not only feasible but importantly confers beneficial effects on glucose control, body composition, and physical function in older adults with T2D.  Further, they provide evidence that bone quality may improve independent of changes in BMD in response to lifestyle intervention. Long-term studies involving a larger sample are needed to follow up on these encouraging results and examine underlying mechanisms.

Nothing to Disclose: AC, DB, YB, GC, RCV, DTV

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