Glucose Lowering through Weight Management (GLoW)
Research type
Research Study
Full title
A single-blind, parallel-group, randomised trial to evaluate the clinical and cost-effectiveness of a tailored diabetes education and behavioural weight management programme versus diabetes education, in adults with overweight or obesity and a new diagnosis of type 2 diabetes.
IRAS ID
236767
Contact name
Carolyn Read
Contact email
Sponsor organisation
University of Cambridge, School of Clinical Medicine
Duration of Study in the UK
2 years, 1 months, 1 days
Research summary
Summary of Research
Type 2 diabetes is typically characterised as a progressive irreversible condition. However, there is evidence that people with type 2 diabetes can achieve good glucose control or even remission through weight loss. Most studies that demonstrate this have used bariatric surgery or formula diets, which are rarely commissioned in the UK because of their high cost and reliance on specialists. Standard care for people with a new diagnosis of type 2 diabetes is structured diabetes education, which has low uptake and small, short term effects on weight and blood glucose.The GLoW (Glucose Lowering through Weight management) trial will evaluate whether a tailored behavioural weight management programme that can be delivered at scale achieves better glucose control and other health outcomes than education alone and whether any improvements in health and wellbeing justify the higher cost of the programme.
We will recruit 576 adults with overweight and obesity who have been diagnosed with type 2 diabetes within the last 3 years. We will randomly allocate them to either a structured diabetes education programme or a new programme that combines diabetes education and dietitian support with 6 months attendance at a weekly commercial weight management group (Weight Watchers).
Participants will be followed up at 6 months and 1 year, and we will measure clinical outcomes (such as blood glucose and body weight), diet and physical activity behaviours, and use of medications and other health care resources. We will analyse which group has better changes in health outcomes and which programme offers best value for money. Findings from this trial will inform the decisions of commissioners of services for weight management and diabetes about the most cost-effective use of limited health-care resources.
Summary of Results
Why is this study important?
Losing weight can help people living with type 2 diabetes to improve their average blood sugar (“HbA1c”) and reduce their risk for heart disease. Previous studies have shown that “formula diets” (which completely replace all meals with a very low calorie formula) can help people lose a substantial amount of weight, but these programmes are expensive and might not be acceptable or suitable for everyone.Behavioural weight management programmes aim to help people lose weight by changing their behavior, for example by improving their diet or exercising more. Such programmes can help people lose weight. At the moment most people with type 2 diabetes in the UK get education about diabetes but there is no evidence that this really helps either with blood sugar or long-term weight loss.
What was our aim?
The aim of our study was to find out whether a new programme combining diabetes education with behavioural weight management would help people with a recent diagnosis of type 2 diabetes to lower their average blood sugar, lose weight, achieve remission, and improve cardiovascular risk. We aimed to compare this new programme with the “standard care” that people with type 2 diabetes currently get in the UK. We also aimed to examine whether this new programme is good value for money.What did we do?
We recruited 577 adults living with overweight or obesity who had been diagnosed with type 2 diabetes within the past 3 years. We randomly allocated study participants to one of two groups:
• People in the intervention group were given access to the “Live Well With Diabetes” programme. They received two telephone calls from a registered dietitian, and 6 months’ access to WW (formerly Weight Watchers), a behavioural programme which involves weekly group meetings and digital resources like the WW app.
• People in the standard care group received access to “DESMOND”, a diabetes education workshop which takes place over 6 hours and is led by a registered dietitian.
We measured average blood sugar, weight, other medical tests (like cholesterol), and self-reported questionnaires (on eating behaviour, diabetes-related quality of life, and wellbeing) at the start of the study, at 6 months and at 12 months.What did we find?
The change in average blood sugar from the start of the study to 12 months later was similar in the two groups. The intervention group lost 1.97 kg more weight at 6 months and 1.46 kg more weight at 12 months than the standard care group. Adults in the intervention group were more than twice as likely to achieve “diabetes remission” at 6 and 12 months as those receiving standard care. “Remission” was defined as having an average blood glucose level lower than 48mmol/mol without being prescribed diabetes mediation.What’s the take-home message?
The tailored diabetes education and behavioural weight management programme (= the intervention) did not improve average blood sugar compared to the standard care diabetes education, but it did help people lose more weight and achieve diabetes remission.The tailored diabetes education and weight management programme was more expensive than current standard care. However, when we looked at the impact of the intervention on health and health care costs over a lifetime, we showed that investing in the more expensive programme would be better value for money.
Summary of Results
Why is this study important?
Losing weight can help people living with type 2 diabetes to improve their average blood sugar (“HbA1c”) and reduce their risk for heart disease. Previous studies have shown that “formula diets” (which completely replace all meals with a very low calorie formula) can help people lose a substantial amount of weight, but these programmes are expensive and might not be acceptable or suitable for everyone.Behavioural weight management programmes aim to help people lose weight by changing their behavior, for example by improving their diet or exercising more. Such programmes can help people lose weight. At the moment most people with type 2 diabetes in the UK get education about diabetes but there is no evidence that this really helps either with blood sugar or long-term weight loss.
What was our aim?
The aim of our study was to find out whether a new programme combining diabetes education with behavioural weight management would help people with a recent diagnosis of type 2 diabetes to lower their average blood sugar, lose weight, achieve remission, and improve cardiovascular risk. We aimed to compare this new programme with the “standard care” that people with type 2 diabetes currently get in the UK. We also aimed to examine whether this new programme is good value for money.What did we do?
We recruited 577 adults living with overweight or obesity who had been diagnosed with type 2 diabetes within the past 3 years. We randomly allocated study participants to one of two groups:
• People in the intervention group were given access to the “Live Well With Diabetes” programme. They received two telephone calls from a registered dietitian, and 6 months’ access to WW (formerly Weight Watchers), a behavioural programme which involves weekly group meetings and digital resources like the WW app.
• People in the standard care group received access to “DESMOND”, a diabetes education workshop which takes place over 6 hours and is led by a registered dietitian.
We measured average blood sugar, weight, other medical tests (like cholesterol), and self-reported questionnaires (on eating behaviour, diabetes-related quality of life, and wellbeing) at the start of the study, at 6 months and at 12 months.What did we find?
The change in average blood sugar from the start of the study to 12 months later was similar in the two groups. The intervention group lost 1.97 kg more weight at 6 months and 1.46 kg more weight at 12 months than the standard care group. Adults in the intervention group were more than twice as likely to achieve “diabetes remission” at 6 and 12 months as those receiving standard care. “Remission” was defined as having an average blood glucose level lower than 48mmol/mol without being prescribed diabetes mediation.What’s the take-home message?
The tailored diabetes education and behavioural weight management programme (= the intervention) did not improve average blood sugar compared to the standard care diabetes education, but it did help people lose more weight and achieve diabetes remission.The tailored diabetes education and weight management programme was more expensive than current standard care. However, when we looked at the impact of the intervention on health and health care costs over a lifetime, we showed that investing in the more expensive programme would be better value for money.
REC name
East of Scotland Research Ethics Service REC 1
REC reference
18/ES/0048
Date of REC Opinion
15 May 2018
REC opinion
Further Information Favourable Opinion