The psychological component of comprehensive lifestyle modification program in overweight (obese) patients with type 2 diabetes mellitus

Background. Despite the emergence of new modern classes of antihyperglycemic medications, lifestyle modification of patient with type 2 diabetes mellitus (T2DM) is a necessary component of the therapeutic approach in this disease. Clinically significant weight reduction and its maintenance is extremely important, but elusive goal for most patients with T2DM in the real clinical practice. The use of specially developed programs with involvement of the different profiles specialists (endocrinologists, dieticians, psychologists, instructors or сlinical exercise physiologists) can greatly contribute to this task.

Aims — to study individual psychological characteristics in overweight (obese) patients with T2DM and to evaluate the dynamic of these characteristics, anthropometric, clinical and metabolic parameters during the comprehensive lifestyle modification program.

Material and methods. The lifestyle modification program was developed. The main structural components of this program were dietary intervention, dosed individualized exercise intervention, specific model of team psychotherapeutic work (health coaching), comprehensive group education and dynamic medical support of patients with the adaptation of drug therapy. Psychological characteristics of patients, clinical and metabolic parameters and the level of physical activity were assessed before inclusion, at 3 and 12 months of follow-up.

Results. The study was completed by 55 people of 60 (5 people dropped out of the study because of various reasons). There were not undesirable phenomena, directly related to participation in the program. At the end of the study we noted the positive dynamics of psychological characteristics in patients: 15% of men and 22% of women became less inclined to self-blame and hyper-responsibility; the locus of control in a relationship to own capabilities of health management changed from external to internal in 30% of women and 41% of men. 65% of participants achieved clinically significant weight loss (most patients reduced MT by 10% or more) and retained this result during 1 year. Improvement of clinical and metabolic parameters was also noted.

Conclusions. The multidisciplinary lifestyle modification program in overweight (obese) patients with T2DM, the most important part of which was team psychotherapeutic work, showed high effectiveness of both the reduction of MT and the improvement of clinical and metabolic parameters in the long-term period.

type 2 diabetes mellitus, obesity, lifestyle modification, coaching, education

1. International Diabetes Federation. IDF atlas (7th edition update). Brussels. 2015.

2. Дедов И.И., Шестакова М.В., Галстян Г.Р. Распространенность сахарного диабета 2-го типа у взрослого населения России (исследование NATION). // Сахарный диабет. — 2016. — Т. 19. — № 2. — С. 104-112. [Dedov II, Shestakova MV, Galstyan GR. The prevalence of type 2 diabetes mellitus in the adult population of Russia (NATION study). Diabetes Mellitus. 2016;19(2):104-112. (In Russ.)]. doi: 10.14341/DM2004116-17

3. Eriksson KF, Lindgärde F. Prevention of Type 2 (non-insulin-dependent) diabetes mellitus by diet and physical exercise The 6-year Malmö feasibility study. Diabetologia. 1991;34(12):891-898. doi: 10.1007/bf00400196

4. Pan XR, Li GW, Hu YH, et al. Effects of Diet and Exercise in Preventing NIDDM in People With Impaired Glucose Tolerance: The Da Qing IGT and Diabetes Study. Diabetes Care. 1997;20(4):537-544. doi: 10.2337/diacare.20.4.537

5. Lindstrom J, Louheranta A, Mannelin M, et al. The Finnish Diabetes Prevention Study (DPS): Lifestyle intervention and 3-year results on diet and physical activity. Diabetes Care. 2003;26(12):3230-3236. doi: 10.2337/diacare.26.12.3230

6. Hamman RF, Wing RR, Edelstein SL, et al. Effect of weight loss with lifestyle intervention on risk of diabetes. Diabetes Care. 2006;29(9):2102-2107. doi: 10.2337/dc06-0560

7. Ramachandran A, Snehalatha C, Mary S, et al. The Indian Diabetes Prevention Programme shows that lifestyle modification and metformin prevent type 2 diabetes in Asian Indian subjects with impaired glucose tolerance (IDPP-1). Diabetologia. 2006;49(2):289-297. doi: 10.1007/s00125-005-0097-z

8. Wing RR, Jakicic J, Neiberg R, et al. Fitness, fatness, and cardiovascular risk factors in type 2 diabetes: look ahead study. Med Sci Sports Exerc. 2007;39(12):2107-2116. doi: 10.1249/mss.0b013e31815614cb

9. Hamdy O, Carver C. The why WAIT program: Improving clinical outcomes through weight management in type 2 diabetes. Curr Diab Rep. 2008;8(5):413-420. doi: 10.1007/s11892-008-0071-5

10. Сахарный диабет: диагностика, лечение, профилактика. / Под ред. Дедова И.И., Шестаковой М.В. — М.: Медицинское информационное агентство; 2011. [Dedov II, Shestakova MV, editors. Sakharnyy diabet: diagnostika, lechenie, profilaktika. Moscow: Meditsinskoe informatsionnoe agentstvo; 2011. (In Russ.)].

11. Дедов И.И., Шестакова М.В., Галстян Г.Р., и др. Алгоритмы специализированной медицинской помощи больным сахарным диабетом. / Под ред. Дедова И.И., Шестаковой М.В. // Сахарный диабет. — 2015. — Т. 18. — № 1S. — C. 1-112. [Dedov II, Shestakova MV, Galstyan GR, et al. Dedov II, Shestakova MV, editors. Standards of specialized diabetes care. Diabetes mellitus. 2015;18(1S):1-112. (In Russ.)]. doi: 10.14341/DM20151S

12. Hulens M, Vansant G, Claessens AL, et al. Predictors of 6-minute walk test results in lean, obese and morbidly obese women. Scand J Med Sci Sports. 2003;13(2):98-105. doi: 10.1034/j.1600-0838.2003.10273.x

13. Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc. 1982;14(5):377-381.

14. Рудина Л.М. Дельта-коучинг в консалтинге и психотерапии. // Теория и практика психотерапии. — 2015. — Т. 2. — № 7. — С. 89-98. [Rudina LM. Delta coaching in the field of consulting and psychotherapy. Teoriya i praktika psikhoterapii. 2015;(7):89-98. (In Russ.)].

15. Шапкин С.А. Экспериментальное изучение волевых процессов. — Москва: Смысл; 1997. [Shapkin SA. Eksperimental’noe izuchenie volevykh protsessov. Moscow: Smysl; 1997. (In Russ.)].

16. Рудина Л.М. Тест на оптимизм: Метод определения атрибутивных стилей. Методическое пособие. / Под ред. Русалова В.М. — М.: Наука; 2002. [Rudina LM. Rusalov VM, editor. Test na optimizm: Metod opredeleniya atributivnykh stiley. Methodical manual. Moscow: Nauka; 2002. (In Russ.)].

17. Ромек В.Г. Поведенческая психотерапия. — М.: Академия; 2002. [Romek VG. Povedencheskaya psikhoterapiya. Mоscоw: Akademiya; 2002. (In Russ.)].