655-P: Effect of an Interdisciplinary Care and Diabetes Self-Management Education Program on Weight among Persons with Social and Clinical Complex Profile

People with diabetes/obesity, especially those on insulin treatment and with the intention of achieving glycemic control goal, may have more difficulty losing weight. Evidence suggests a relationship between social determinants of health (socio-economic status, education, etc.) and worst diabetes-related outcomes. We evaluated the change on weight in patients who attended an Interdisciplinary Care and Diabetes Self-management Education Program in a public primary care specialized diabetes clinic in Mexico City/Iztapalapa in 2018. In 327 persons with type 2 diabetes, body weight and composition were evaluated by bioelectrical impedance multifrequency analysis (Seca® 515/514, 50 Hz). Women represented 67%, 56% had elementary or less education and 63.9% had medium-low or lower socio-economic status. Mean age was 55±10 years old, mean duration of diabetes was 12±8 years, baseline weight was 72.9±16.1 kg and 68% were on insulin treatment. Drugs with recognized weight loss effect were not added. Weight loss was observed after the program: BMI 25-29.9 category (n=118) 1.4 kg (-0.4-2.9 95% CI, p=<0.0001), in BMI 30-34.9category (n=77) 1.9 kg (0.3-4.2 95% CI, p=<0.0001), and in BMI ≥35 category (n=61) 2.5 kg (0.3-5.2 95% CI, p=<0.0001) of weight loss was observed. Proportion of patients with BMI≥30 and weight loss >5% was 26.1%. Fat mass loss was 2.1 kg (0.3-3.1 95% CI, p=<0.0001) in BMI≥30 category. Diet self-care behavior improved (2.6±1.6 to 5.4±0.9 days/week, p=<0.0001), HbA1c decreased (9.45±2.0 to 6.7±1.2%, p=<0.0001) as well as total daily insulin units (36.2±16.9 to 27.2±12.2 units, p=<0.0001) among on-insulin treatment subjects. We show that this strategy non-primarily designed to lose weight but rather to propitiate diabetes empowerment had a valuable positive effect on weight in a real world-setting, even when the studied population has complex and adverse clinical and social features.