Randomized controlled community-based nutrition and exercise intervention improves glycemia and cardiovascular risk factors in type 2 diabetic patients in rural Costa Rica.
OBJECTIVE
The prevalence of type 2 diabetes, especially in developing countries, has grown over the past decades. We performed a controlled clinical study to determine whether a community-based, group-centered public health intervention addressing nutrition and exercise can ameliorate glycemic control and associated cardiovascular risk factors in type 2 diabetic patients in rural Costa Rica.


METHODS
A total of 75 adults with type 2 diabetes, mean age 59 years, were randomly assigned to the intervention group or the control group. All participants received basic diabetes education. The subjects in the intervention group participated in 11 weekly nutrition classes (90 min each session). Subjects for whom exercise was deemed safe also participated in triweekly walking groups (60 min each session). Glycosylated hemoglobin, fasting plasma glucose, total cholesterol, triglycerides, HDL and LDL cholesterol, height, weight, BMI, and blood pressure were measured at baseline and the end of the study (after 12 weeks).


RESULTS
The intervention group lost 1.0 +/- 2.2 kg compared with a weight gain in the control group of 0.4 +/- 2.3 kg (P = 0.028). Fasting plasma glucose decreased 19 +/- 55 mg/dl in the intervention group and increased 16 +/- 78 mg/dl in the control group (P = 0.048). Glycosylated hemoglobin decreased 1.8 +/- 2.3% in the intervention group and 0.4 +/- 2.3% in the control group (P = 0.028).


CONCLUSIONS
Glycemic control of type 2 diabetic patients can be improved through community-based, group-centered public health interventions addressing nutrition and exercise. This pilot study provides an economically feasible model for programs that aim to improve the health status of people with type 2 diabetes.
Goldhaber-Fiebert
Jeremy D
JD
Harvard Medical School, Boston, Massachusetts 02115, USA. sgf@post.harvard.edu
Goldhaber-Fiebert
Sara N
SN
Tristán
Mario L
ML
Nathan
David M
DM
D000368:Aged; D001786:Blood Glucose; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D003364:Costa Rica / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000178:diet therapy* / Q000453:epidemiology*; D015444:Exercise; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000178:diet therapy / Q000453:epidemiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D015596:Nutrition Assessment; D010353:Patient Education as Topic; D010865:Pilot Projects; D015995:Prevalence; D011320:Primary Health Care; D012307:Risk Factors; D012424:Rural Population
D001786:Blood Glucose