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Diet or diet plus physical activity versus usual care in patients with newly diagnosed type 2 diabetes: the Early ACTID randomised controlled trial

Summary Background Lifestyle changes soon after diagnosis might improve outcomes in patients with type 2 diabetes mellitus, but no large trials have compared interventions. We investigated the effects of diet and physical activity on blood pressure and glucose concentrations. Methods We did a random... Full description

Journal Title: The Lancet (British edition) 2011, Vol.378 (9786), p.129-139
Main Author: Andrews, RC, Dr
Other Authors: Cooper, AR, PhD , Montgomery, AA, PhD , Norcross, AJ, MSc , Peters, TJ, Prof , Sharp, DJ, Prof , Jackson, N, BSc , Fitzsimons, K, PhD , Bright, J, MBA , Coulman, K, MSc , England, CY, BSc , Gorton, J, BSc , McLenaghan, A, RN , Paxton, E, BSc , Polet, A, BSc , Thompson, C, Dip HE , Dayan, CM, Prof
Format: Electronic Article Electronic Article
Language: English
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Quelle: Alma/SFX Local Collection
Publisher: Kidlington: Elsevier Ltd
ID: ISSN: 0140-6736
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title: Diet or diet plus physical activity versus usual care in patients with newly diagnosed type 2 diabetes: the Early ACTID randomised controlled trial
format: Article
creator:
  • Andrews, RC, Dr
  • Cooper, AR, PhD
  • Montgomery, AA, PhD
  • Norcross, AJ, MSc
  • Peters, TJ, Prof
  • Sharp, DJ, Prof
  • Jackson, N, BSc
  • Fitzsimons, K, PhD
  • Bright, J, MBA
  • Coulman, K, MSc
  • England, CY, BSc
  • Gorton, J, BSc
  • McLenaghan, A, RN
  • Paxton, E, BSc
  • Polet, A, BSc
  • Thompson, C, Dip HE
  • Dayan, CM, Prof
subjects:
  • Adult
  • Aged
  • Aged, 80 and over
  • Biological and medical sciences
  • Blood pressure
  • Combined Modality Therapy
  • Diabetes
  • Diabetes Mellitus, Type 2 - diet therapy
  • Diabetes Mellitus, Type 2 - therapy
  • Diabetes. Impaired glucose tolerance
  • Diagnosis
  • Diet
  • Diet therapy
  • Endocrine pancreas. Apud cells (diseases)
  • Endocrinopathies
  • Etiopathogenesis. Screening. Investigations. Target tissue resistance
  • Exercise
  • Exercise Therapy
  • Female
  • General aspects
  • Health aspects
  • Health Behavior
  • Health services
  • Heart attacks
  • Hospitals
  • Humans
  • Insulin resistance
  • Intention to Treat Analysis
  • Internal Medicine
  • Intervention
  • Life Style
  • Male
  • Medical sciences
  • Metabolic diseases
  • Middle Aged
  • Nutrition
  • Studies
  • Type 2 diabetes
  • Weight Loss
ispartof: The Lancet (British edition), 2011, Vol.378 (9786), p.129-139
description: Summary Background Lifestyle changes soon after diagnosis might improve outcomes in patients with type 2 diabetes mellitus, but no large trials have compared interventions. We investigated the effects of diet and physical activity on blood pressure and glucose concentrations. Methods We did a randomised, controlled trial in southwest England in adults aged 30–80 years in whom type 2 diabetes had been diagnosed 5–8 months previously. Participants were assigned usual care (initial dietary consultation and follow-up every 6 months; control group), an intensive diet intervention (dietary consultation every 3 months with monthly nurse support), or the latter plus a pedometer-based activity programme, in a 2:5:5 ratio. The primary endpoint was improvement in glycated haemoglobin A1c (HbA1c ) concentration and blood pressure at 6 months. Analysis was done by intention to treat. This study is registered, number ISRCTN92162869. Findings Of 593 eligible individuals, 99 were assigned usual care, 248 the diet regimen, and 246 diet plus activity. Outcome data were available for 587 (99%) and 579 (98%) participants at 6 and 12 months, respectively. At 6 months, glycaemic control had worsened in the control group (mean baseline HbA1c percentage 6·72, SD 1·02, and at 6 months 6·86, 1·02) but improved in the diet group (baseline-adjusted difference in percentage of HbA1c −0·28%, 95% CI −0·46 to −0·10; p=0·005) and diet plus activity group (−0·33%, −0·51 to −0·14; p
language: eng
source: Alma/SFX Local Collection
identifier: ISSN: 0140-6736
fulltext: fulltext
issn:
  • 0140-6736
  • 1474-547X
url: Link


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titleDiet or diet plus physical activity versus usual care in patients with newly diagnosed type 2 diabetes: the Early ACTID randomised controlled trial
sourceAlma/SFX Local Collection
creatorAndrews, RC, Dr ; Cooper, AR, PhD ; Montgomery, AA, PhD ; Norcross, AJ, MSc ; Peters, TJ, Prof ; Sharp, DJ, Prof ; Jackson, N, BSc ; Fitzsimons, K, PhD ; Bright, J, MBA ; Coulman, K, MSc ; England, CY, BSc ; Gorton, J, BSc ; McLenaghan, A, RN ; Paxton, E, BSc ; Polet, A, BSc ; Thompson, C, Dip HE ; Dayan, CM, Prof
creatorcontribAndrews, RC, Dr ; Cooper, AR, PhD ; Montgomery, AA, PhD ; Norcross, AJ, MSc ; Peters, TJ, Prof ; Sharp, DJ, Prof ; Jackson, N, BSc ; Fitzsimons, K, PhD ; Bright, J, MBA ; Coulman, K, MSc ; England, CY, BSc ; Gorton, J, BSc ; McLenaghan, A, RN ; Paxton, E, BSc ; Polet, A, BSc ; Thompson, C, Dip HE ; Dayan, CM, Prof
descriptionSummary Background Lifestyle changes soon after diagnosis might improve outcomes in patients with type 2 diabetes mellitus, but no large trials have compared interventions. We investigated the effects of diet and physical activity on blood pressure and glucose concentrations. Methods We did a randomised, controlled trial in southwest England in adults aged 30–80 years in whom type 2 diabetes had been diagnosed 5–8 months previously. Participants were assigned usual care (initial dietary consultation and follow-up every 6 months; control group), an intensive diet intervention (dietary consultation every 3 months with monthly nurse support), or the latter plus a pedometer-based activity programme, in a 2:5:5 ratio. The primary endpoint was improvement in glycated haemoglobin A1c (HbA1c ) concentration and blood pressure at 6 months. Analysis was done by intention to treat. This study is registered, number ISRCTN92162869. Findings Of 593 eligible individuals, 99 were assigned usual care, 248 the diet regimen, and 246 diet plus activity. Outcome data were available for 587 (99%) and 579 (98%) participants at 6 and 12 months, respectively. At 6 months, glycaemic control had worsened in the control group (mean baseline HbA1c percentage 6·72, SD 1·02, and at 6 months 6·86, 1·02) but improved in the diet group (baseline-adjusted difference in percentage of HbA1c −0·28%, 95% CI −0·46 to −0·10; p=0·005) and diet plus activity group (−0·33%, −0·51 to −0·14; p<0·001). These differences persisted to 12 months, despite less use of diabetes drugs. Improvements were also seen in bodyweight and insulin resistance between the intervention and control groups. Blood pressure was similar in all groups. Interpretation An intensive diet intervention soon after diagnosis can improve glycaemic control. The addition of an activity intervention conferred no additional benefit. Funding Diabetes UK and the UK Department of Health.
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subjectAdult ; Aged ; Aged, 80 and over ; Biological and medical sciences ; Blood pressure ; Combined Modality Therapy ; Diabetes ; Diabetes Mellitus, Type 2 - diet therapy ; Diabetes Mellitus, Type 2 - therapy ; Diabetes. Impaired glucose tolerance ; Diagnosis ; Diet ; Diet therapy ; Endocrine pancreas. Apud cells (diseases) ; Endocrinopathies ; Etiopathogenesis. Screening. Investigations. Target tissue resistance ; Exercise ; Exercise Therapy ; Female ; General aspects ; Health aspects ; Health Behavior ; Health services ; Heart attacks ; Hospitals ; Humans ; Insulin resistance ; Intention to Treat Analysis ; Internal Medicine ; Intervention ; Life Style ; Male ; Medical sciences ; Metabolic diseases ; Middle Aged ; Nutrition ; Studies ; Type 2 diabetes ; Weight Loss
ispartofThe Lancet (British edition), 2011, Vol.378 (9786), p.129-139
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11Gorton, J, BSc
12McLenaghan, A, RN
13Paxton, E, BSc
14Polet, A, BSc
15Thompson, C, Dip HE
16Dayan, CM, Prof
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descriptionSummary Background Lifestyle changes soon after diagnosis might improve outcomes in patients with type 2 diabetes mellitus, but no large trials have compared interventions. We investigated the effects of diet and physical activity on blood pressure and glucose concentrations. Methods We did a randomised, controlled trial in southwest England in adults aged 30–80 years in whom type 2 diabetes had been diagnosed 5–8 months previously. Participants were assigned usual care (initial dietary consultation and follow-up every 6 months; control group), an intensive diet intervention (dietary consultation every 3 months with monthly nurse support), or the latter plus a pedometer-based activity programme, in a 2:5:5 ratio. The primary endpoint was improvement in glycated haemoglobin A1c (HbA1c ) concentration and blood pressure at 6 months. Analysis was done by intention to treat. This study is registered, number ISRCTN92162869. Findings Of 593 eligible individuals, 99 were assigned usual care, 248 the diet regimen, and 246 diet plus activity. Outcome data were available for 587 (99%) and 579 (98%) participants at 6 and 12 months, respectively. At 6 months, glycaemic control had worsened in the control group (mean baseline HbA1c percentage 6·72, SD 1·02, and at 6 months 6·86, 1·02) but improved in the diet group (baseline-adjusted difference in percentage of HbA1c −0·28%, 95% CI −0·46 to −0·10; p=0·005) and diet plus activity group (−0·33%, −0·51 to −0·14; p<0·001). These differences persisted to 12 months, despite less use of diabetes drugs. Improvements were also seen in bodyweight and insulin resistance between the intervention and control groups. Blood pressure was similar in all groups. Interpretation An intensive diet intervention soon after diagnosis can improve glycaemic control. The addition of an activity intervention conferred no additional benefit. Funding Diabetes UK and the UK Department of Health.
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13Endocrine pancreas. Apud cells (diseases)
14Endocrinopathies
15Etiopathogenesis. Screening. Investigations. Target tissue resistance
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21Health Behavior
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24Hospitals
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27Intention to Treat Analysis
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29Intervention
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33Metabolic diseases
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38Weight Loss
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titleDiet or diet plus physical activity versus usual care in patients with newly diagnosed type 2 diabetes: the Early ACTID randomised controlled trial
authorAndrews, RC, Dr ; Cooper, AR, PhD ; Montgomery, AA, PhD ; Norcross, AJ, MSc ; Peters, TJ, Prof ; Sharp, DJ, Prof ; Jackson, N, BSc ; Fitzsimons, K, PhD ; Bright, J, MBA ; Coulman, K, MSc ; England, CY, BSc ; Gorton, J, BSc ; McLenaghan, A, RN ; Paxton, E, BSc ; Polet, A, BSc ; Thompson, C, Dip HE ; Dayan, CM, Prof
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7Diabetes Mellitus, Type 2 - diet therapy
8Diabetes Mellitus, Type 2 - therapy
9Diabetes. Impaired glucose tolerance
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12Diet therapy
13Endocrine pancreas. Apud cells (diseases)
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16Exercise
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21Health Behavior
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25Humans
26Insulin resistance
27Intention to Treat Analysis
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30Life Style
31Male
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35Nutrition
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37Type 2 diabetes
38Weight Loss
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abstractSummary Background Lifestyle changes soon after diagnosis might improve outcomes in patients with type 2 diabetes mellitus, but no large trials have compared interventions. We investigated the effects of diet and physical activity on blood pressure and glucose concentrations. Methods We did a randomised, controlled trial in southwest England in adults aged 30–80 years in whom type 2 diabetes had been diagnosed 5–8 months previously. Participants were assigned usual care (initial dietary consultation and follow-up every 6 months; control group), an intensive diet intervention (dietary consultation every 3 months with monthly nurse support), or the latter plus a pedometer-based activity programme, in a 2:5:5 ratio. The primary endpoint was improvement in glycated haemoglobin A1c (HbA1c ) concentration and blood pressure at 6 months. Analysis was done by intention to treat. This study is registered, number ISRCTN92162869. Findings Of 593 eligible individuals, 99 were assigned usual care, 248 the diet regimen, and 246 diet plus activity. Outcome data were available for 587 (99%) and 579 (98%) participants at 6 and 12 months, respectively. At 6 months, glycaemic control had worsened in the control group (mean baseline HbA1c percentage 6·72, SD 1·02, and at 6 months 6·86, 1·02) but improved in the diet group (baseline-adjusted difference in percentage of HbA1c −0·28%, 95% CI −0·46 to −0·10; p=0·005) and diet plus activity group (−0·33%, −0·51 to −0·14; p<0·001). These differences persisted to 12 months, despite less use of diabetes drugs. Improvements were also seen in bodyweight and insulin resistance between the intervention and control groups. Blood pressure was similar in all groups. Interpretation An intensive diet intervention soon after diagnosis can improve glycaemic control. The addition of an activity intervention conferred no additional benefit. Funding Diabetes UK and the UK Department of Health.
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