Amanda Avery*1, Jenny Barber2, Asma Zina Belheddad3, Carolyn Pallister2, Josef Toon4, Sarah Bennett4 and Jacquie Lavin4
Received:October 25, 2021; Published:November 09, 2021
Corresponding author: Dr. Amanda Avery, Associate professor in Nutrition & Dietetics, Division of Food, Nutrition & Dietetics, School of Biosciences, University of Nottingham, UK
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What is already known about the subject?
a) Weight management may prevent, help manage and reverse T2D and improve glycaemic control and metabolic risk, without the need to increase insulin doses, in those with T1D affected by overweight or obesity.
b) Weight loss is the primary driver of T2D remission and that it does not matter what dietary approach is used providing the person is able to follow the diet in order to achieve long-term weight loss.
c) Given the increasing prevalence of T2D and T1D that is associated with overweight or obesity, scalable solutions are required to support people with either type of diabetes to better manage their weight What is the Key Question?
Can a community-based weight management programme, that is scalable and where people can either be referred to or selfselect to join, offer weight management support to adults with T2 and T1D in order to improve their glycaemic control and, for some with T2D, lead to the reversal of their diabetes management. Can this support lead to better mental well-being and be easy to follow in order to achieve long-term improvements?
What are the new findings?
a) 62.3% study participants, members of Slimming World, achieved a weight loss ≥10% and were 7.3 times more likely to achieve a HbA1c level of ≤48mmol/mol compared to those achieving smaller weight losses (OD: 7.261, 95%CI= 2.583-20.409). Those study participants who were referred by a healthcare professional did better.
b) 33.9% study participants with T2D suggested their diabetes diagnosis was reversed following the lifestyle changes made through membership at Slimming World. This number increased to over 50% in those achieving ≥10% weight loss.
c) The majority of study participants found it very easy or easy to follow the lifestyle guidance encouraged by Slimming World. At the time of the survey, mental health well-being had improved.
How might this impact clinical practice?
Scalable options are required to support people with T1 & T2D to better manage their weight and for those with T2D to promote a significant weight loss that may help reverse their condition. Less intensive, community-based options that are accessible to all people for both when and for how long they require the support need to be considered. Referral and support from a healthcare professional may improve the outcomes
Aim/Hypothesis: This mixed-methods evaluation investigates the impact of Slimming World (SW) membership on weight, glycaemic control and mental-health related quality of life in adults with both T1D and T2D who either self-referred or were referred by a healthcare professional. It also evaluates the ease of application and the accessibility of the support offered to determine longterm sustainability of the lifestyle changes made. The hypothesis was that both glycaemic control and improvements in mental well-being are positively associated with weight loss and that participants would find the intervention easy to follow and achieve weight loss (≥10%).
Methods: Adult members of SW with diabetes (T1 & T2D) were invited to complete a questionnaire available on SW’s website for a week, with qualitative and quantitative questions including age-range, length of membership, self-reported weight, height and HbA1c levels before and at the time of survey (t1), medication use, questions related to changes in mental well-being and their experience of being able to integrate diet and physical activity advice provided by their healthcare team. Statistical analyses were undertaken on SPSS Statistics (v. 26).
Results: Among 268 respondents, 83.2% had T2D. 88.7% (238) were female and median age of surveyed members was 50-59 years. Median length of membership, 1-2years; median time since diagnosis, 6-10 years and 68.5% reported being diagnosed ≥6yrs. Where data was provided, mean (SD) BMI and HbA1c on joining were 38.9±7.83kg/m2 and 76.6 ±37.4mmol/mol with 74.4% reporting a HbA1c above 53 mmol/mol. Reported mean % weight and HbA1c reductions since joining were 13.0±9.03% and 21.9±29.7mmol/mol respectively at t1. 62.3% achieved a weight loss ≥10% and were 7.3 times more likely to achieve a HbA1c level ≤48mmol/mol compared to those achieving smaller weight losses (OD: 7.261, 95%CI= 2.583-20.409). Reduction in HbA1c levels was independent of diabetes duration or insulin therapy status. A third (33.9%) of respondents with T2D suggested their diabetes diagnosis had been reversed. Those referred for weight loss by their healthcare professional had greater HbA1c reductions (p<0.05). At t1, 44.0% respondents (T2D) indicated their diabetes medication had been reduced or stopped. This increased to 60.8% where weight loss ≥10%. At t1, 80.4% showed improved mental-health related quality of life (p<0.05). 75.6% of respondents (T1D 68.4%; T2D 76.5%) reported finding it very easy/easy to incorporate personal lifestyle advice from their healthcare practitioner into the healthy eating and activity plan. Very few (n=20) reported challenges.
Conclusions: Slimming World support is a feasible and effective strategy in reducing weight and improving glycaemic control in adults with either T1 or T2D, with almost two-thirds of the study population achieving ≥10% weight loss and being able to reduce their diabetes medications and/or reverse their diabetes diagnosis. Mental-health related quality of life can also be improved. Referral by healthcare professionals increased the improved glycaemic control achieved and where people had been given advice by their healthcare professional, it was generally easy to incorporate this guidance.
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