Purpose: Implementation of prevention trials in patients with or at-high-risk for type 2 diabetes (T2D) is important to reduce disease burden in older adults. We assessed the effectiveness of a lifestyle intervention delivered by peer-leaders (Peer Only) alone or enhanced with telehealth (Peer & TeleH) to improve weight and glycemic management.
Methods: In a pilot study, 300 older adults (75% with T2D and 25% with prediabetes) from South Florida (USA) were randomly assigned to Peer Only, Peer & TeleH, or Standard care interventions and followed-up for 6 months. Interventions were based on modules used in the Diabetes Prevention Program. A peer-leader manual and mobile platform for the telehealth intervention were prepared based on input from focus groups among potential participants. T-tests were used to evaluate differences between treatment groups.
Results: Participants had a mean age of 67.1 ± 5.4 years; 94.7% were male, 38.7% were Black, and 21.7% were Hispanic. At baseline, average weight was 229.2 ± 43.7 lbs, BMI was 34.3 ± 6.4 kg/m², and cholesterol was 162.5 ±40.9. Compared to the Standard care group, being in the Peer only group was associated with significant BMI reduction (p<0.01) after 6 months. In contrast, the Peer & TeleH group had a significantly greater, and substantial, reduction in fasting glucose (mg/dl) (p<0.05), particularly for participants with T2D (see Table).
Conclusions: Lifestyle interventions delivered through peer-leaders and/or enhanced with telehealth are feasible and effective for weight and glycemic management in older adults with or at-high-risk for T2D. However, results are not consistent across outcome measures. Assessment of the impact on self-efficacy, quality of life and cost-effectiveness of these strategies are warranted to plan for broader implementation.
Values are mean ± standard deviation; *p<0.05, **p<0.01 (vs. Standard care)