Background

Many programs for diabetes focus on glycemic outcomes and do not address excess weight or behaviors that drive type 2 diabetes (T2DM). Our center's Weight Wellness (WW) clinic is a multidisciplinary program for weight management that is separate to the Standard Endocrinology (SE) clinic. We hypothesized that patients seen in WW would have better glycemic and body weight outcomes compared to SE.

Methods

Medical records were extracted for patients with T2DM seen in WW and SE clinics between 1/1/2016 and 11/20/2018. Comparisons of WW and SE patients were performed on baseline patient data including demographics, lab values, and medications. Primary outcomes included absolute and percentage weight change, change in BMI, and change in hemoglobin A1c (HbA1c) between initial and last visits.

Results

Analysis was performed on data from 513 patients seen in WW and 2,225 patients seen in SE who had a diagnosis of T2DM and BMI>25 kg/m2. Baseline data on glucose control was similar between WW and SE (15% and 14% of patients had initial HbA1c >9%, respectively), while mean BMI at baseline was greater for patients seen in WW (38.5 vs. 32.7 kg/m2).Mean weight change between first and last visits was significantly different between clinics (-5.0 kg for WW and -1.4 kg for SE, p<0.01).WW had a smaller proportion of patients who gained weight (21%) compared to SE (41%). WW also had a larger proportion of patients who lost >5% of initial weight (42%) compared to SE (24%).Patients seen in WW were more likely to have HbA1c <7% (70% vs 53%, p<0.01) at their most recent visit. Statistically significant improvements were also seen in serum HDL and ALT in WW patients compared to SE.

Conclusions

Our results suggest that a multidisciplinary WW clinic that focuses on lifestyle modification and weight management may have better glycemic outcomes for patients with T2DM than SE care. The significant decrease in body weight seen in WW compared to SE may have additional health benefits, including improvements in ALT.