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A very low-carbohydrate diabetes prevention program for veterans with prediabetes: a single-arm mixed methods pilot study

INTRODUCTION: All Veterans Affairs (VA) Medical Centers offer the MOVE! Weight Management Program to help patients achieve and maintain a healthy weight through a calorie-restricted, low-fat diet and increased physical activity. Yet, most MOVE! participants do not achieve clinically significant weig...

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Autores principales: Griauzde, Dina H., Hershey, Cheryl, Michaels, Jamie, Evans, Richard R., Richardson, Caroline R., Heisler, Michele, Kullgren, Jeffrey T., Saslow, Laura R.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10230095/
https://www.ncbi.nlm.nih.gov/pubmed/37266128
http://dx.doi.org/10.3389/fnut.2023.1069266
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author Griauzde, Dina H.
Hershey, Cheryl
Michaels, Jamie
Evans, Richard R.
Richardson, Caroline R.
Heisler, Michele
Kullgren, Jeffrey T.
Saslow, Laura R.
author_facet Griauzde, Dina H.
Hershey, Cheryl
Michaels, Jamie
Evans, Richard R.
Richardson, Caroline R.
Heisler, Michele
Kullgren, Jeffrey T.
Saslow, Laura R.
author_sort Griauzde, Dina H.
collection PubMed
description INTRODUCTION: All Veterans Affairs (VA) Medical Centers offer the MOVE! Weight Management Program to help patients achieve and maintain a healthy weight through a calorie-restricted, low-fat diet and increased physical activity. Yet, most MOVE! participants do not achieve clinically significant weight loss of ≥5%. A carbohydrate-restricted diet may help more Veterans to achieve ≥5% weight loss. METHODS: This was a single-arm explanatory sequential mixed methods pilot study conducted in one VA health care system. Veterans with prediabetes and body mass index ≥25 kg/m2 were invited to participate in a group-based, virtual, very low-carbohydrate Diabetes Prevention Program (VLC-DPP) consisting of 23 sessions over 12 months. Participants were taught to follow a very low-carbohydrate eating pattern, defined as 20–35 grams of net carbohydrates per day. The primary outcomes were measures of feasibility and acceptability, including program uptake and session attendance. Secondary outcomes included change in weight, hemoglobin A1c, lipids, and patient-reported measures of food cravings, stress eating, perceived health status, and motivation. Interviews were conducted at 6 months to identify factors that facilitated or hindered participants’ achievement of ≥5% weight loss. RESULTS: Among 108 screened Veterans, 21 enrolled in the study (19%), and 18 were included in the analytic cohort. On average, participants attended 12.4/16 weekly sessions and 3.6/8 bimonthly or monthly sessions. At 12 months, mean percent weight loss was 9.4% (SD = 10.7) with 9 participants (50%) achieving ≥5% weight loss. Three factors facilitated achievement of ≥5% weight loss among 10/16 interviewees: (1) enjoyment of low-carbohydrate foods; (2) careful monitoring of carbohydrate intake; and (3) reduced hunger and food cravings. Three factors hindered achievement of ≥5% weight loss among 6/16 interviewees: (1) food cravings, particularly for sweets; (2) challenges with maintaining a food log; and (3) difficulty with meal planning. CONCLUSION: A VLC-DPP is feasible and acceptable and shows preliminary efficacy among Veterans with prediabetes. The program’s weight loss effectiveness compared to standard MOVE! should be evaluated in a larger-scale trial. Such a program may be offered in addition to the standard MOVE! program to expand the menu of evidence-based lifestyle counseling options for Veterans. CLINICAL TRIAL REGISTRATION: https://clinicaltrials.gov/ct2/show/NCT04881890, identifier NCT04881890.
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spelling pubmed-102300952023-06-01 A very low-carbohydrate diabetes prevention program for veterans with prediabetes: a single-arm mixed methods pilot study Griauzde, Dina H. Hershey, Cheryl Michaels, Jamie Evans, Richard R. Richardson, Caroline R. Heisler, Michele Kullgren, Jeffrey T. Saslow, Laura R. Front Nutr Nutrition INTRODUCTION: All Veterans Affairs (VA) Medical Centers offer the MOVE! Weight Management Program to help patients achieve and maintain a healthy weight through a calorie-restricted, low-fat diet and increased physical activity. Yet, most MOVE! participants do not achieve clinically significant weight loss of ≥5%. A carbohydrate-restricted diet may help more Veterans to achieve ≥5% weight loss. METHODS: This was a single-arm explanatory sequential mixed methods pilot study conducted in one VA health care system. Veterans with prediabetes and body mass index ≥25 kg/m2 were invited to participate in a group-based, virtual, very low-carbohydrate Diabetes Prevention Program (VLC-DPP) consisting of 23 sessions over 12 months. Participants were taught to follow a very low-carbohydrate eating pattern, defined as 20–35 grams of net carbohydrates per day. The primary outcomes were measures of feasibility and acceptability, including program uptake and session attendance. Secondary outcomes included change in weight, hemoglobin A1c, lipids, and patient-reported measures of food cravings, stress eating, perceived health status, and motivation. Interviews were conducted at 6 months to identify factors that facilitated or hindered participants’ achievement of ≥5% weight loss. RESULTS: Among 108 screened Veterans, 21 enrolled in the study (19%), and 18 were included in the analytic cohort. On average, participants attended 12.4/16 weekly sessions and 3.6/8 bimonthly or monthly sessions. At 12 months, mean percent weight loss was 9.4% (SD = 10.7) with 9 participants (50%) achieving ≥5% weight loss. Three factors facilitated achievement of ≥5% weight loss among 10/16 interviewees: (1) enjoyment of low-carbohydrate foods; (2) careful monitoring of carbohydrate intake; and (3) reduced hunger and food cravings. Three factors hindered achievement of ≥5% weight loss among 6/16 interviewees: (1) food cravings, particularly for sweets; (2) challenges with maintaining a food log; and (3) difficulty with meal planning. CONCLUSION: A VLC-DPP is feasible and acceptable and shows preliminary efficacy among Veterans with prediabetes. The program’s weight loss effectiveness compared to standard MOVE! should be evaluated in a larger-scale trial. Such a program may be offered in addition to the standard MOVE! program to expand the menu of evidence-based lifestyle counseling options for Veterans. CLINICAL TRIAL REGISTRATION: https://clinicaltrials.gov/ct2/show/NCT04881890, identifier NCT04881890. Frontiers Media S.A. 2023-05-17 /pmc/articles/PMC10230095/ /pubmed/37266128 http://dx.doi.org/10.3389/fnut.2023.1069266 Text en Copyright © 2023 Griauzde, Hershey, Michaels, Evans, Richardson, Heisler, Kullgren and Saslow. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Nutrition
Griauzde, Dina H.
Hershey, Cheryl
Michaels, Jamie
Evans, Richard R.
Richardson, Caroline R.
Heisler, Michele
Kullgren, Jeffrey T.
Saslow, Laura R.
A very low-carbohydrate diabetes prevention program for veterans with prediabetes: a single-arm mixed methods pilot study
title A very low-carbohydrate diabetes prevention program for veterans with prediabetes: a single-arm mixed methods pilot study
title_full A very low-carbohydrate diabetes prevention program for veterans with prediabetes: a single-arm mixed methods pilot study
title_fullStr A very low-carbohydrate diabetes prevention program for veterans with prediabetes: a single-arm mixed methods pilot study
title_full_unstemmed A very low-carbohydrate diabetes prevention program for veterans with prediabetes: a single-arm mixed methods pilot study
title_short A very low-carbohydrate diabetes prevention program for veterans with prediabetes: a single-arm mixed methods pilot study
title_sort very low-carbohydrate diabetes prevention program for veterans with prediabetes: a single-arm mixed methods pilot study
topic Nutrition
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10230095/
https://www.ncbi.nlm.nih.gov/pubmed/37266128
http://dx.doi.org/10.3389/fnut.2023.1069266
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