Open Access Research article

Effects of lifestyle education program for type 2 diabetes patients in clinics: a cluster randomized controlled trial

Misa Adachi1, Kazue Yamaoka2*, Mariko Watanabe3, Masako Nishikawa4, Itsuro Kobayashi5, Eisuke Hida6 and Toshiro Tango6

Author Affiliations

1 Nutrition Support Network LLC, 2-2-4 Wakamatu, Sagamihara, Kanagawa, 252-0334, Japan

2 Teikyo University, Graduate School of Public Health, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan

3 Showa Women’s University, Graduate School of Life Science, 1-7 Taishido, Setagaya, Tokyo, 154-0004, Japan

4 Department of Technology Assessment and Biostatistics, National Institute of Public Health, 2-3-6 Minami, Wako, Saitama, 351-0197, Japan

5 Kobayashi Medical Clinic, Ryokujukai Cooperation, 5-27-28 Sagamiono, Sagamihara, Kanagawa, 252-0303, Japan

6 Center for Medical Statistics, SAN Building 401, 2-9-6 Higashi Shinbashi, Minato-ku, Tokyo, 105-0021, Japan

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BMC Public Health 2013, 13:467  doi:10.1186/1471-2458-13-467

Published: 14 May 2013



The prevalence of type 2 diabetes is rising worldwide, as has been the global mean fasting plasma glucose level. This study aimed to evaluate the effectiveness of a structured individual-based lifestyle education (SILE) program to reduce the hemoglobin A1c (HbA1c) level in type 2 diabetes patients delivered by registered dietitians in primary care clinical settings.


This was a 6-month prospective cluster randomized controlled trial in a primary care setting with randomization at the practice level. Twenty general practitioners in 20 clinics in Kanagawa prefecture, Japan, were involved. 193 adults (51% men, mean age 61.3 years) with type 2 diabetes and HbA1c ≥6.5% who received treatment in medical clinics were the participants. A SILE program was implemented through 4 sessions with trained registered dietitians during the 6-month study period. Results were compared with those of a control group who received usual care. The primary endpoint was the change in HbA1c levels at 6 months from baseline. Secondary endpoints were the changes at 6 months from baseline in fasting plasma glucose, lipid profile, blood pressure, BMI, energy, and nutrient intakes (whole day and each meal). Intention-to-treat analysis was conducted. Mixed-effects linear models were used to examine the effects of the treatment.


The mean change at 6 months from baseline in HbA1c was a 0.7% decrease in the intervention group (n = 100) and a 0.2% decrease in the control group (n = 93) (difference −0.5%, 95%CI: -0.2% to −0.8%, p = 0.004). After adjusting for baseline values and other factors, the difference was still significant (p = 0.003 ~ 0.011). The intervention group had a significantly greater decrease in mean energy intake at dinner compared with the control group and a greater increase in mean vegetable intake for the whole day, breakfast, and lunch as shown in crude and adjusted models. A tendency toward improvement was observed in the other secondary endpoints but the improvement was not statistically significant. These results were confirmed by several sensitivity analyses.


The SILE program that was provided in primary care settings for patients with type 2 diabetes resulted in greater improvement in HbA1c levels than usual diabetes care and education.

Trial registration

http://UMIN000004049 webcite

Diabetes type 2; Lifestyle education; Cluster randomized trial; Dietary habit; Food frequency questionnaire