For people with difficult-to-control diabetes, adding intensive weight management counseling to group medical visits provided extra health benefits beyond improved blood-sugar control, according to a study led by researchers at the Duke Diet & Fitness Center and the Department of Veterans Affairs.

The weight counseling approach emphasized a low-carb diet, with participants logging better weight loss, less use of diabetes medications and fewer potentially dangerous episodes of plummeting blood sugar levels compared to study participants who only attended group diabetes sessions.

The findings are publishing online Nov. 4 in JAMA Internal Medicine.

"Group medical visits are an increasingly popular way to care for diabetes patients," said lead author William Yancy, M.D., director of the Duke Diet & Fitness Center and research associate at the Durham VA Medical Center. "This approach can be efficient for patients who share a common chronic condition, enabling them to receive education, self-management skills training, and medication management to improve clinical outcomes.

"At the Duke Diet & Fitness Center and in our previous studies, we've also had great success with group programs for weight management," Yancy said. "This study married the two approaches."

Yancy and colleagues enrolled 263 people with uncontrolled diabetes and followed them over the one-year study.

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Half of the participants were randomly assigned to participate in group medical visits monthly for four months to learn how to manage their diabetes. The other half were assigned to group medical visits that included intensive diet coaching aimed at keeping them on a low-carbohydrate regimen. This group met every two weeks for four months.

After the first four months, both groups met every eight weeks until the study ended.

Initially, participants who had the diet intervention showed marked improvement in blood glucose control compared to those in the other group, but by the end of the study, those differences evened out and both interventions proved similarly helpful in lowering glucose levels.

However, the addition of weight management counseling provided extra health benefits, including weight loss and a 50-percent reduction in incidents of hypoglycemia. What's more, diabetes medication use declined for participants in the weight management group while it rose in the other group.

"Intensive weight management using a low-carbohydrate diet can be as effective for glycemic improvement as medication intensification," Yancy said. "We know that lifestyle changes can be difficult to maintain, but this study shows that group meetings can be an efficient and effective strategy that helps patients sustain these improvements."

In addition to Yancy, study authors include Matthew J. Crowley, Moahad S. Dar, Cynthia J. Coffman, Amy S. Jeffreys, Matthew L. Maciejewski, Corrine I. Voils, Anna Barton Bradley and David Edelman.

The study received support from the Department of Veterans Affairs (IIR 13-053, RCS 10-391, RCS 14-443), the Durham Center of Innovation to Accelerate Discovery and Practice Transformation at the Durham Veterans Administration Health Care System (CIN 13-410), Veterans Affairs Health Services Research and Development (13-261), and the National Institutes of Health (T-32 2T32DK007012-36A1).