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Journal Club

Journal Club. Wadden TA, Volger S, Sarwer DB, Vetter ML, Tsai AG, Berkowitz RI, Kumanyika S, Schmitz KH, Diewald LK, Barg R, Chittams J, Moore RH. A two-year randomized trial of obesity treatment in primary care practice. N Engl J Med. 2011 Nov 24;365(21):1969-79. Epub 2011 Nov 14.

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Journal Club

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  1. Journal Club Wadden TA, Volger S, Sarwer DB, Vetter ML, Tsai AG, Berkowitz RI, Kumanyika S, Schmitz KH, Diewald LK, Barg R, Chittams J, Moore RH. A two-year randomized trial of obesity treatment in primary care practice. N Engl J Med. 2011 Nov 24;365(21):1969-79. Epub 2011 Nov 14. Noble D, Mathur R, Dent T, Meads C, Greenhalgh T. Risk models and scores for type 2 diabetes: systematic review. BMJ. 2011 Nov 28;343:d7163. doi: 10.1136/bmj.d7163. • 埼玉医科大学　総合医療センター　内分泌・糖尿病内科 • Department of Endocrinology and Diabetes, • Saitama Medical Center, Saitama Medical University • 松田　昌文 • Matsuda, Masafumi 2011年12月8日　8:30-8:55 ８階　医局

  2. weight reduction program

  3. the Departments of Psychiatry (T.A.W., S.V., D.B.S., M.L.V., R.I.B., L.K.D., R.H.M.), Surgery (D.B.S.), and Medicine (M.L.V.) and the Center for Clinical Epidemiology and Biostatistics (S.K., K.H.S., J.C., R.H.M.), the Perelman School of Medicine at the University of Pennsylvania; the Department of Child and Adolescent Psychiatry, Children’s Hospital of Philadelphia (R.I.B.); and Penn Medicine, Clinical Care Associates (R.B.) — all in Philadelphia; and the Division of General Internal Medicine and Center for Human Nutrition, University of Colorado, Aurora (A.G.T.) N Engl J Med 2011;365:1969-79.

  4. Background Calls for primary care providers (PCPs) to offer obese patients behavioral weight-loss counseling have not been accompanied by adequate guidance on how such care could be delivered. This randomized trial compared weight loss during a 2-year period in response to three lifestyle interventions, all delivered by PCPs in collaboration with auxiliary health professionals (lifestyle coaches) in their practices.

  5. Methods We randomly assigned 390 obese adults in six primary care practices to one of three types of intervention: usual care, consisting of quarterly PCP visits that included education about weight management; brief lifestyle counseling, consisting of quarterly PCP visits combined with brief monthly sessions with lifestyle coaches who instructed participants about behavioral weight control; or enhanced brief lifestyle counseling, which provided the same care as described for the previous intervention but included meal replacements orweight-loss medication (orlistat or sibutramine),chosen by the participants in consultation with the PCPs, to potentially increase weight loss.

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  8. Results Of the 390 participants, 86% completed the 2-year trial, at which time, the mean (±SE) weight loss with usual care, brief lifestyle counseling, and enhanced brief lifestyle counseling was 1.7±0.7, 2.9±0.7, and 4.6±0.7 kg, respectively. Initial weight decreased at least 5% in 21.5%, 26.0%, and 34.9% of the participants in the three groups, respectively. Enhanced lifestyle counseling was superior to usual care on both these measures of success (P = 0.003 and P = 0.02, respectively), with no other significant differences among the groups. The benefits of enhanced lifestyle counseling remained even after participants given sibutramine were excluded from the analyses. There were no significant differences between the intervention groups in the occurrence of serious adverse events.

  9. Conclusions Enhanced weight-loss counseling helps about one third of obese patients achieve longterm, clinically meaningful weight loss. (Funded by the National Heart, Lung, and Blood Institute; POWER-UP ClinicalTrials.gov number, NCT00826774.)

  10. Message/Comments 肥満患者390人を対象に、プライマリ・ケア提供者による減量カウンセリングの効果を2年間の無作為化試験で比較。減量平均値は医師の指導のみ、医師＋生活改善コーチの指導、医師＋コーチの指導＋代用食/減量薬の各群で、1.7±0.7、2.9±0.7、4.6±0.7kgだった。減量薬服用者を分析から除外しても減量効果が見られた。

  11. http://cvrisk.mvm.ed.ac.uk/calculator/calc.asp

  12. http://aricnews.net/DiabRisk/DiabRC1.html

  13. Objective To evaluate current risk models and scores for type 2 diabetes and inform selection and implementation of these in practice.

  14. Design Systematic review using standard (quantitative) and realist (mainly qualitative) methodology. Inclusion criteria Papers in any language describing the development or external validation, or both, of models and scores to predict the risk of an adult developing type 2 diabetes. Data sources Medline, PreMedline, Embase, and Cochrane databases were searched. Included studies were citation tracked in Google Scholar to identify follow-on studies of usability or impact. Data extraction Data were extracted on statistical properties of models, details of internal or external validation, and use of risk scores beyond the studies that developed them. Quantitative data were tabulated to compare model components and statistical properties. Qualitative data were analysed thematically to identify mechanisms by which use of the risk model or score might improve patient outcomes.

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