Lifestyle intervention in obese patients with type 2 diabetes: impact of the patient's educational background

Objective: To determine whether people with different educational backgrounds respond differently to a lifestyle intervention program for obese patients with type 2 diabetes. Research Methods and Procedures: The study consisted of a 12‐month randomized controlled trial of 147 health plan members with type 2 diabetes who were overweight or obese (BMI ≥ 27 kg/m²). Participants were randomized to lifestyle case management or usual care. Case management (CM) involved group and individual education, support, and referral by registered dietitians. Usual care (UC) participants received educational material. Both groups received ongoing primary care. A post hoc analysis was performed, evaluating the impact of education level on intervention group differences with respect to change in weight and waist circumference. Results: There was a significant education by group interaction for both changes in weight (p = 0.02) and waist circumference (p = 0.01) during the study period. Contrary to expectations, CM participants with less formal education had greater risk reductions compared with more educated participants. Models predicted that, by 12 months, those with less education in the UC group gained 1.71 kg more in weight and 3.67 cm more in waist circumference than those with greater education. However, by 12 months, those in the CM group with less education lost a model‐predicted 3.30 kg more in weight and 4.95 cm more in waist circumference than those with more formal education. Discussion: People with varied educational backgrounds may respond differently to a lifestyle intervention for weight management and diabetes control.