Abstract
Targeting body weight, as an alternative model to targeting hemoglobin A1c, is emerging as a viable and potentially cost-effective approach to diabetes management in clinical practice. Why WAIT (Weight Achievement and Intensive Treatment) is a 12-week multidisciplinary program for weight control and intensive diabetes management specifically designed for application in routine diabetes practice. The program, which is generally covered by insurance, is followed by continuous support aimed at long-term maintenance of weight loss and diabetes control. This model was effective in improving key metabolic abnormalities observed in diabetic patients. Eighty-two percent of participants achieved the target hemoglobin A1c of less than 7% on less diabetes medications. The achieved weight reduction after 12 weeks of intervention was maintained for an additional year. Future dissemination of this intervention model in routine clinical practice may require wider endorsement by third-party payers and support of governmental health care agencies to halt the progression of the epidemic of obesity and diabetes in the United States.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References and Recommended Reading
King H, Aubert RE, Herman WH: Global burden of diabetes, 1995–2025: prevalence, numerical estimates, and projections. Diabetes Care 1998, 21:1414–1431.
Flegal KM, Carroll MD, Ogden CL, Johnson CL: Prevalence and trends in obesity among US adults, 1999–2000. JAMA 2002, 288:1723–1727.
Lin SX, Pi-Sunyer EX: Prevalence of the metabolic syndrome among US middle-aged and older adults with and without diabetes—a preliminary analysis of the NHANES 1999–2002 data. Ethn Dis 2007, 17:35–39.
Turner RC, Cull CA, Frighi V, Holman RR: Glycemic control with diet, sulfonylurea, metformin, or insulin in patients with type 2 diabetes mellitus: progressive requirement for multiple therapies (UKPDS 49). UK Prospective Diabetes Study (UKPDS) Group. JAMA 1999, 281:2005–2012
Henry RR, Gumbiner B, Ditzler T, et al.: Intensive conventional insulin therapy for type II diabetes. Metabolic effects during a 6-mo outpatient trial. Diabetes Care 1993, 16:21–31
Hamdy O, Ledbury S, Mullooly C, et al.: Lifestyle modification improves endothelial function in obese subjects with the insulin resistance syndrome. Diabetes Care 2003, 26:2119–2125.
Monzillo LU, Hamdy O, Horton ES, et al.: Effect of lifestyle modification on adipokine levels in obese subjects with insulin resistance. Obes Res 2003, 11:1048–1054.
Pi-Sunyer X, Blackburn G, Brancati FL, et al.: Reduction in weight and cardiovascular disease risk factors in individuals with type 2 diabetes: one-year results of the look AHEAD trial. Diabetes Care. 2007, 30:1374–1383.
Price JH, Desmond SM, Krol RA, et al.: Family practice physicians’ beliefs, attitudes, and practices regarding obesity. Am J Prev Med 1987, 3:339–345.
Hill JO, Wyatt H: Outpatient management of obesity: a primary care perspective. Obes Res 2002, 10(Suppl 2):124S–130S.
Becker RH, Frick AD: Clinical pharmacokinetics and pharmacodynamics of insulin glulisine. Clin Pharmacokinet 2008, 47:7–20.
Dornhorst A, Lüddeke HJ, Sreenan S, et al.: Insulin detemir improves glycaemic control without weight gain in insulinnaïve patients with type 2 diabetes: subgroup analysis from the PREDICTIVE study. Int J Clin Pract 2008, 62:659–665.
Rosenstock J, Davies M, Home PD, et al.: A randomised, 52-week, treat-to-target trial comparing insulin detemir with insulin glargine when administered as add-on to glucose-lowering drugs in insulin-naive people with type 2 diabetes. Diabetologia 2008, 51:408–416.
Giusti J, Rizzotto JA: Interpreting the Joslin Diabetes Center and Joslin Clinic Clinical Nutrition Guideline for Overweight and Obese Adults With Type 2 Diabetes. Curr Diab Rep 2006, 6:405–408.
Campbell A: Tackling “diabesity” head-on. Joslin Diabetes Center’s new nutrition guideline. Diabetes Self Manag 2005, 22:40, 42–44.
Fenicchia LM, Kanaley JA, Azevedo JL Jr, et al.: Influence of resistance exercise training on glucose control in women with type 2 diabetes. Metabolism 2004, 53:284–289.
Cuff DJ, Meneilly GS, Martin A, et al.: Effective exercise modality to reduce insulin resistance in women with type 2 diabetes. Diabetes Care 2003, 26:2977–2982.
Daly RM, Dunstan DW, Owen N, et al.: Does high-intensity resistance training maintain bone mass during moderate weight loss in older overweight adults with type 2 diabetes? Osteoporos Int 2005, 16:1703–1712.
Knowler WC, Barrett-Connor E, Fowler SE, et al.: Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002, 346:393–403.
Wadden TA, Osei S: The treatment of obesity: an overview. In Handbook of Obesity Treatment. Edited by Wadden TA, Stunkard AJ. New York, NY: Guildford Press; 2002:229–248.
Hickman IJ, Jonsson JR, Prins JB, et al.: Modest weight loss and physical activity in overweight patients with chronic liver disease results in sustained improvements in alanine aminotransferase, fasting insulin, and quality of life. Gut 2004, 53:413–419.
Dixon JB, Bhathal PS, O’Brien PE: Weight loss and non-alcoholic fatty liver disease: falls in gamma-glutamyl transferase concentrations are associated with histologic improvement. Obes Surg 2006, 16:1278–1286.
Hsieh CJ, Wang PW: Effectiveness of weight loss in the elderly with type 2 diabetes mellitus. J Endocrinol Invest 2005, 28:973–977.
Parker B, Noakes M, Luscombe N, Clifton P: Effect of a high-protein, high-monounsaturated fat weight loss diet on glycemic control and lipid levels in type 2 diabetes. Diabetes Care 2002, 25:425–430.
Navarro-Diaz M, Serra A, Romero R, et al.: Effect of drastic weight loss after bariatric surgery on renal parameters in extremely obese patients: long-term follow-up. J Am Soc Nephrol 2006, 17(12 Suppl 3):S213–S217.
Saiki A, Nagayama D, Ohhira M, et al.: Effect of weight loss using formula diet on renal function in obese patients with diabetic nephropathy. Int J Obes (Lond) 2005, 29:1115–1120.
Skov AR, Toubro S, Bulow J, et al.: Changes in renal function during weight loss induced by high vs low-protein low-fat diets in overweight subjects. Int J Obes Relat Metab Disord 1999, 23:1170–1177.
Gannon MC, Nuttall FQ: Control of blood glucose in type 2 diabetes without weight loss by modification of diet composition. Nutr Metab (Lond) 2006, 3:16.
Brinkworth GD, Noakes M, Parker B, et al.: Long-term effects of advice to consume a high-protein, low-fat diet, rather than a conventional weight-loss diet, in obese adults with type 2 diabetes: one-year follow-up of a randomised trial. Diabetologia 2004, 47:1677–1686.
Aucott L, Poobalan A, Smith WC, et al.: Weight loss in obese diabetic and non-diabetic individuals and long-term diabetes outcomes—a systematic review. Diabetes Obes Metab 2004, 6:85–94.
Yu AP, Wu EQ, Birnbaum HG, et al.: Short-term economic impact of body weight change among patients with type 2 diabetes treated with antidiabetic agents: analysis using claims, laboratory, and medical record data. Curr Med Res Opin 2007, 23:2157–2169.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Hamdy, O., Carver, C. The why WAIT program: Improving clinical outcomes through weight management in type 2 diabetes. Curr Diab Rep 8, 413–420 (2008). https://doi.org/10.1007/s11892-008-0071-5
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11892-008-0071-5