Personal Coaching Halts Progression to Diabetes in Some Patients, Study Finds

March 6, 2015

A unique coaching project included not only traditional elements like nutrition and exercise but also stress management and sleep.

A comprehensive coaching program, which combined traditional elements like nutrition and exercise counseling with efforts to control stress and correct disrupted sleep, succeeded in reversing elevated blood glucose levels in nearly half the patients with prediabetes who took part.

Results of the study, released this week by the American College of Cardiology (ACC), will be presented next week at the group’s 64th annual meeting in San Diego, California. The study’s lead author, Mariam Kashani, DNP, is the chief scientific director at Walter Reed National Military Center, Bethesda, Maryland.

The study reports results of the Integrative Cardiac Health Project, which promotes healthy behavior to improve overall health and reduce cardiac risk. Researchers evaluated data for 508 consecutive participants, who were assessed for cardiovascular health and given personalized evaluations, featuring individual goals that met recognized preventive care guidelines.

Of the participants, 107 had prediabetes, which meant their blood glucose levels were elevated but not enough to be diagnosed with type 2 diabetes mellitus (T2DM). Prediabetes is defined as glucose >100 mg/dL and <140 mg/dL.

Participants then took part in 14 coaching sessions over a 6-month period, either in person or by telephone, with specialists in nutrition, exercise, sleep, and stress management. Researchers sought to measure the effect of the intervention on blood glucose levels and other risk factors.

Of the participants who had prediabetes, 49% were able to revert to their blood glucose to <100 mg/dL, regardless of whether they lost weight, which the researchers found notable. On average, participants who were able to regain normal glucose metabolism lowered their fasting glucose level by 12%, dropping from 105.4 to 92.4 mg/dL.

“Many more patients reverted to normal blood glucose than expected, especially if we consider that they were not necessarily losing weight,” Dr Kashani said in a statement released by ACC. “This is important because prediabetes is a modifiable risk factor for cardiovascular disease.”

The measurable reductions in blood glucose levels were significant, she said, because each 5 mg/dL reduction brings a significant reduction in cardiovascular risk. Patients with prediabetes also showed improvements in blood pressure, fasting insulin, perceived stress levels, adherence to a Mediterranean diet, and reported feeling less tired.

A major limitation is that the study is observational and had no control group. However, Dr Kashani said those who were able to revert to normal blood glucose levels also had significantly lower triglyceride levels at 6 months compared with others who remained prediabetic. A study to compare this lifestyle intervention to usual care is underway, according to the ACC statement.

Dr Kashani said the findings show that interventions must go beyond diet and exercise to include other factors. “By taking sleep and stress into account, we factor in important hormonal processes to better manage glucose,” she said in the ACC statement. “When we are stressed, our bodies release extra glucose and when we are tired, we tend to make poor food choices. In this context, people often regain weight, and in doing so, they may revert back to worsening blood glucose levels.”

According to the American Diabetes Association, an estimated 86 million Americans have prediabetes, and 1 in 3 will develop T2DM within 5 years if elevated blood glucose levels are not addressed. Risk increases with a family history of diabetes, weight gain, and a sedentary lifestyle.