Members of our research faculty will convene with behavioral health researchers and clinicians at the 40th Annual Society of Behavioral Medicine conference in Washington D.C.. The annual meeting is attended by clinicians, educators, and scientists in the interdisciplinary field of behavioral medicine. The Society of Behavioral Medicine (SBM) is composed of roughly 2,400 behavioral and biomedical researchers and clinicians from more than 20 disciplines, brought together by their focus on the role of behavior in improving health.
Caroline Richardson, M.D., the Dr. Max and Buena Lichter Research Professor of Family Medicine, will discussion topics ranging from gender and self reported physical activity, the integration of low-carbohydrate diet interventions in diabetes prevention, and lifestyle interventions in the 2017 updated guidelines for hypertensions
See #SBM2019 offerings from our research faculty:
Friday, March 8, 2019
Panel 21: Managing Hypertension: Behavioral Medicine’s Role in Leading the Narrative
With the update of the American College of Cardiology/American Heart Association (ACC/AHA) blood pressure guidelines in late 2017, millions of Americans were instantly diagnosed with hypertension as the diagnostic threshold changed from 140/90mmHg to 130/80mmHg. Notably, many of those newly diagnosed with hypertension are not individuals for whom antihypertensive medication would be most appropriate. And yet, much of the discussion in the 2017 ACC/AHA guidelines—and news coverage of the guidelines—surrounded using medication to manage high blood pressure. Even though lifestyle changes have been shown to be effective in managing hypertension in primary care, evidence-based treatment approaches such as behavioral interventions for promoting smoking cessation, weight loss, and reduced alcohol consumption were not incorporated in substantial detail in the practice recommendations. Instead, the guidelines included only two references to the sizeable body of evidence providing support for lifestyle modification for treating high blood pressure. Moreover, of the 20 members of the 2017 ACC/AHA blood pressure guidelines writing committee, none were behavioral scientists.
In line with the Society of Behavioral Medicine 40th annual meeting theme of “Leading the Narrative,” this panel discussion will address how behavioral medicine researchers and practitioners can play a pivotal role in the “narrative” of how to effectively manage high blood pressure. This panel brings together experts from behavioral medicine, cardiology, and family medicine in order to foster a dialogue about the 2017 ACC/AHA blood pressure guidelines from different perspectives. Drs. Jun Ma (University of Illinois at Chicago), Lawrence Fine (NHLBI), Corrine Voils (University of Wisconsin), and Caroline Richardson (University of Michigan) will bring their expertise to a number of relevant topics, including the role that lifestyle modification can play in successfully managing hypertension and how it can be used in conjunction with medication, issues surrounding blood pressure monitoring and medication adherence and how behavioral interventions can improve adherence, and factors related to implementing blood pressure management guidelines in primary care. The panel will also provide a forum for interaction with session attendees, particularly regarding generating strategies for supporting the dissemination and implementation of evidence-based lifestyle approaches for managing hypertension.
Learning Objective 1: Upon completion, participant will be able to describe the role of lifestyle modification in successful management of hypertension
Learning Objective 2: Upon completion, participant will be able to explain how behavioral interventions can promote adherence to blood pressure monitoring and medication
1 - 2 PM
Location: Georgetown East
A Pilot Study of a Low-Carbohydrate Diabetes Prevention Program Among People with Prediabetes
Background: The Diabetes Prevention Program (DPP) can help individuals with prediabetes to achieve an average of 4 percent body weight loss through a low-fat, calorie-restricted diet. However, low-carbohydrate diets may be more effective for weight loss and glycemic control among individuals with diabetes (5, 6), suggesting the potential for similar benefits in a prediabetic population.
Objectives: 1) To evaluate feasibility and acceptability of a Low-Carbohydrate Diabetes Prevention Program (LC-DPP) and 2) To estimate weight loss from a LC-DPP among individuals with prediabetes.
Methods: This was a single-arm mixed methods pilot study. The intervention was conducted in partnership with the National Kidney Foundation of Michigan (NKFM) and delivered at one of our University’s primary care clinical sites. Study inclusion criteria were: BMI ³ 25 kg/m2 and prediabetes (defined as HbA1c 5.7-6.4% and absence of T2DM). Eligible participants were identified by chart review and invited to participate in the study via mailed letter. We adapted the Center for Disease Control and Prevention’s National Diabetes Prevention Program (16-weekly core session, 8 bimonthly or monthly post-core sessions) and trained a lifestyle coach to teach participants to follow a very low carbohydrate diet (< 35 grams per day). Primary outcomes were feasibility (rate of recruitment) and acceptability (session attendance, qualitative feedback obtained during semi-structured interviews at 6 months). Secondary outcomes were change in weight and hemoglobin A1c at 6. The study is ongoing and primary and secondary outcomes will also be evaluated at 12-months.
Results: Twelve percent of individuals (22/187) who were invited to participate enrolled in the study and had a mean age was 59 years, BMI of 34.2 kg/m2, HbA1c of 5.9%. Over half (n=12, 55%) of participants were men. Twenty-one individuals attended 3 or more core sessions and 14 individuals attended 9 or more core sessions. At 6 months, average weight loss was 4.4% with 43% of participants achieving 5% body weight loss and 24% achieving 7% body weight loss. HbA1c decreased by an average of 0.1% in all participants and 0.2% in participants who attended more than 9 sessions. Qualitative interviews (n=13) revealed themes of subjective health benefits beyond weight loss and relative ease of learning a low-carbohydrate lifestyle. Barriers included social pressures and concerns about inclusion of high dietary fat intake. There were no significant changes in physical symptoms (e.g. thirst, constipation) and one participant suffered an ischemic stroke during the 6-month study period.
Conclusions: A LC-DPP is feasible, acceptable, and may be an effective and scalable tool to prevent T2DM. Additional insight will be enhanced by 12-month data and interviews and future comparative effectiveness trials.
6:30 - 7:30 PM
Saturday, March 9, 2019
Gender differences in self-reported physical activity levels compared to objective measures from a Fitbit tracking device
Increasing availability of commercially available physical activity (PA) tracking devices, worn by individuals, provides opportunity for objectively measuring PA. However, because of factors such as cost and willingness to wear the device, it is not always feasible to rely on this method. Differences between PA measured directly with a device such as an accelerometer compared to self-reported PA are well-documented; furthermore, gender differences in agreement between the two methods have been highlighted. No studies, however, have directly compared objective PA assessment via Fitbit device with a validated self-report assessment. Our aim was to explore gender differences in level of agreement between self-reported versus objectively measured PA using a Fitbit device.
PA was self-reported by a cohort of male and female veterans participating in a randomized clinical trial of Stay Strong, a mobile-Health intervention aimed at increasing PA and computed as “Active Minutes” (the number of moderate plus vigorous PA per week). AMs were also objectively assessed via a Fitbit Charge 2 device worn by individuals for one week. Regression was used to test for gender differences in agreement between self-reported and Fitbit AMs.
355 (90 women, 265 men) veterans with average age of 39.8 years were included in this study. Women reported lower PA than men based on self-reported AMs (pth percentile (79.5 AMs), median (177 AMs), or 75th percentile (343 AMs) of Fitbit-tracked AMs, self-reported AMs that were 185%, 101% and 62% of their Fitbit AMs, respectively.
Primary care providers are increasingly eliciting PA level as a “vital sign” for use within clinics. We found no gender differences in agreement between self-report and Fitbit-tracked PA in contrast with earlier reviews citing gender differences. However, individuals, overall, tended to over-report PA compared to Fitbit-tracked PA when Fitbit-tracked PA levels were low and under-report PA when Fitbit-tracked PA levels were high. Our findings suggest that caution is warranted when eliciting self-reported PA levels depending on the magnitude of reported PA.
10:30 - 11:30 AM