ABSTRACT
PURPOSE: We tested the feasibility and preliminary efficacy of a lifestyle intervention for middle-aged and older patients with schizophrenia and type-2 diabetes mellitus, using a randomized pre-test, post-test control group design. METHOD: Individuals with a diagnosis of schizophrenia or schizoaffective disorder over the age of 40 were randomly assigned to 24-week Diabetes Awareness and Rehabilitation Training (DART; n=32) groups or Usual Care plus Information (UCI; n=32) comparison groups. Participants were recruited from board-and-care facilities and day treatment programs. Fifty-seven patients completed baseline and 6-month assessments consisting of an interview, measures of body mass index, blood pressure, fasting blood chemistry, and accelerometry. A mixed-model analysis of variance was used to analyze the data. RESULTS: A significant group x time interaction was found for body weight, with patients in the DART group losing a mean of 5 lb and those in the UCI gaining a mean 6 lb. Significant group x time interactions were also found for triglycerides, diabetes knowledge, diabetes self-efficacy, and self-reported physical activity, but not for fasting plasma glucose or glycosylated hemoglobin. CONCLUSIONS: Group-based lifestyle interventions are feasible and produce positive health changes in middle-aged and older patients with schizophrenia and diabetes mellitus.
Subject(s)
Diabetes Mellitus/therapy , Diet, Reducing , Exercise , Life Style , Schizophrenia/therapy , Adult , Aged , Aged, 80 and over , Analysis of Variance , Blood Glucose , Blood Pressure , Body Mass Index , Demography , Fasting , Female , Glucose Tolerance Test , Humans , Male , Middle Aged , Schizophrenia/complicationsABSTRACT
OBJECTIVE: To investigate whether blood pressure is different in type 2 diabetic patients on a diet rich in carbohydrates versus a diet rich in cis-monounsaturated fatty acids. Data on the dietary effects on these diets' glucose and lipid metabolism have been previously published. RESEARCH DESIGN AND METHODS: The study compared the effect of feeding 42 type 2 diabetic patients a carefully controlled isoenergic high-carbohydrate (high-carb; 55% energy as carbohydrate, 30% as fat, and 10% as monounsaturated fat) and high-monounsaturated fat (high-mono; 45% energy as fat, 25% as monounsaturated fat, and 40% as carbohydrate) diet for 6 weeks each in a four-center, randomized, cross-over study on blood pressure. Twenty-one patients continued the diet they received during the second phase for an additional 8 weeks. RESULTS: According to repeated-measures ANOVA, blood pressure during the last 3 days of each phase was similar after 6 weeks of the high-carb and high-mono diets (systolic blood pressure: 128 +/- 16 vs. 127 +/- 15 mmHg, P = 0.9; diastolic blood pressure: 75 +/- 7 vs. 75 +/- 8 mmHg, P = 0.7). However, after 14 weeks of the high-carb diet (n = 13), there was a significant increase in blood pressure compared with 6 weeks of the high-mono diet (systolic blood pressure: 132 +/- 13 vs. 126 +/- 11 mmHg, P = 0.04; diastolic blood pressure: 83 +/- 6 vs. 76 +/- 7 mmHg, P = 0.002). After 14 weeks of the high-mono diet (n = 8), the reduction in blood pressure was not significant compared with 6 weeks of the high-carb diet (systolic blood pressure: 118 +/- 14 vs. 121 +/- 16 mmHg, P = 0.4; diastolic blood pressure: 71 +/- 8 vs. 75 +/- 10 mmHg, P = 0.3). CONCLUSION: Although the exchange of carbohydrates with monounsaturated fats may not affect blood pressure in the short term, long-term consumption of a high-carbohydrate diet may modestly raise blood pressure in type 2 diabetic patients.
