title: The Prevention Of WEight Regain in diabetes type 2 (POWER) study: the effectiveness of adding a combined psychological intervention to a very low calorie diet, design and pilot data of a randomized controlled trial.
abstract: BACKGROUND
  Obesity is of major pathogenetic importance to type 2 diabetes, it contributes to poor glycemic control and increases the risk of cardiovascular disease. Over 80% of patients with diabetes type 2 are overweight. To achieve a more favourable risk profile, changes in diet and lifestyle are needed. However, current treatment programs for obese DM type 2 patients are not effective in the long term. In this RCT, we compare the effectiveness of a Combined Psychological Intervention (CPI) and usual care in maintaining the favourable effects on weight and risk profile during 2 years of follow-up after a Very Low Calorie Diet (VLCD).
  
  
  METHODS
  In a randomised parallel group intervention study, 140 patients with type 2 diabetes and overweight (BMI>27 kg/m2) will be recruited from the outpatient department of the Erasmus Medical Centre.After obtaining ≥5% of weight loss with a VLCD, participants will be randomly assigned to CPI or usual care for 10 weeks. CPI consists of cognitive behaviour therapy, problem solving therapy and proactive coping.Primary outcome measure is weight change (kg).Other outcome measures are Body Mass Index (BMI = weight (kg)/length (m)2), waist circumference (cm), systolic blood pressure (mmHg), HbA1c (mmol/mol), lipid levels (LDL, HDL, TG (mmol/l) and chol/HDL-ratio), antidiabetic agents and doses, cardiovascular risk profile (UKPDS), lifestyle and quality of life (EuroQol EQ-5D). Psychosocial parameters are also studied, as secondary outcomes as well as determinants for weight loss.When successful, we want to conduct an analysis of the cost effectiveness of the intervention as compared to usual care.
  
  
  CONCLUSIONS
  We expect that a CPI after a VLCD will be effective in maintaining weight loss and improving cardiovascular risk and glycaemic control, while being cost-effective and improving quality of life in patients with type 2 diabetes.
  
  
  BACKGROUND
  trialregister.nl NTR2264.
authors.affiliation: Department of Internal Medicine, division of Pharmacology, Vascular and Metabolic diseases, Erasmus Medical Centre, Rotterdam, The Netherlands.
authors.forename: Kirsten A C
authors.initials: KA
authors.lastname: Berk
authors.forename: Hanneke
authors.initials: H
authors.lastname: Buijks
authors.forename: Behiye
authors.initials: B
authors.lastname: Ozcan
authors.forename: Adriaan
authors.initials: A
authors.lastname: Van't Spijker
authors.forename: Jan J V
authors.initials: JJ
authors.lastname: Busschbach
authors.forename: Eric J G
authors.initials: EJ
authors.lastname: Sijbrands
mesh_terms: D000223:Adaptation, Psychological; D031204:Caloric Restriction / Q000379:methods*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003131:Combined Modality Therapy / Q000379:methods; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000178:diet therapy / Q000523:psychology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D050177:Overweight / Q000517:prevention & control* / Q000523:psychology; D010865:Pilot Projects; D011340:Problem Solving; D011615:Psychotherapy, Group / Q000379:methods*; D012107:Research Design; D018570:Risk Assessment; D016896:Treatment Outcome