American Osteopathic Association

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Community-based Lifestyle Intervention Reduces Cardiovascular Disease Risk Factors in Type 2 Diabetes Patients

The Journal of the American Osteopathic Association study finds two months of healthy living classes significantly reduced risk of common diabetes complications in Appalachia

CHICAGO — February 1, 2016 — It took just 16 two-hour classes on the basics of a healthy lifestyle to substantially reduce cardiovascular risks associated with type 2 diabetes and elevated fasting blood glucose levels for 110 patients, according to a study published in The Journal of the American Osteopathic Association.

The Complete Health Improvement Lifestyle Intervention Program (CHIP) includes dietary targets, cooking classes, an exercise program and group discussions to give participants the specifics they need to improve their health. Based on the fact that 75 percent or more of Western diseases are lifestyle-related, CHIP gives participants concrete instruction that takes a mind, body and spirit approach to healthy living.

The retrospective study evaluated 2011-2014 data collected from 110 patients in six Ohio University CHIP cohorts from 11 Appalachian counties where the prevalence of diabetes is over 7 percent higher than the national average. Participants experienced significant reductions in total cholesterol levels (9.6 percent), fasting glucose (9 percent), body mass index (3.7 percent) and systolic blood pressure (5.7 percent). (See data table)

Table 2.

Changes in Cardiovascular Disease Risk Factor Among Patients in CHIP Diabetes

Risk Factors ​  n​ ​Change, Mean (%) SD​ P Value​
​BMI, kg/m2  ​109 ​−3.68 (−1.27) ​0.898  ​<.001
​SBP, mm Hg  ​106 ​−5.65 (−7.46) ​14.5 ​<.001
DBP, mm Hg ​ ​106 ​−1.94 (−1.49) ​10.0 ​>.05
​TC, mg/dL  ​110 ​ −9.64 (−17.7) ​29.4 ​<.001
​LDL-C, mg/dL  ​106 ​−11.4 (−12.4) ​25.4 ​<.001
HDL-C, mg/dL ​ ​110 ​−11.9 (−5.48) ​6.52  ​ <.001
TG, mg/dL ​ ​110 ​−6.48 (−10.1) ​64.3  ​>.05
FBG, mg/dL ​ ​110 ​−9.31 (−11.1) ​28.9 ​<.001

Values in parentheses indicate absolute mean changes from baseline. Data were not available for all participants.

Abbreviations: BMI, body mass index; CHIP, Complete Health Improvement Program; DBP, diastolic blood pressure; FBG, fasting blood glucose; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; SBP, systolic blood pressure; TC, total cholesterol; TG, triglycerides.

“This study supports the osteopathic philosophy of medicine, including that diet and exercise are the most effective prescriptions physicians can give patients struggling with lifestyle diseases like type 2 diabetes. But lifestyle changes require more commitment than taking a pill, which is why programs like CHIP are so beneficial,” said Jay Shubrook, DO, a diabetologist at Touro University California, College of Osteopathic Medicine in Vallejo. “Community-based interventions provide the social supports and specific instruction that move patients into healthy habits, which in some cases enabled them to reduce medications.”

The primary focus of CHIP was the consumption of whole foods, such as fresh fruits, vegetables, whole grains, legumes, nuts and eight 10-oz glasses of water daily. More specific goals included overall dietary fat content below 20 percent of total calories, daily intake of added sugar less than 10 tsp, daily sodium less than 2000 mg, cholesterol below 50 mg, and high fiber intake (>35 g/d).  Stress reduction techniques and flexibility exercises were taught and encouraged, along with at least 30 minutes (or 10,000 steps) of daily aerobic exercise.

Currently almost 30 million Americans have diabetes and 1 in 3 Americans have prediabetes. Diabetes complications include cardiovascular disease, stroke, limb amputation and microvascular complications. Direct medical costs for diabetes in the U.S. are estimated at $176 billion annually. Indirect costs from disability, work lost and premature death add up to another $69 billion.

To date, CHIP has shown to be effective in maintaining reductions in CVD risk factors for up to three years after completion of the program.

“This program engages the community to strive for and reach better health, while preparing participants with the structure they need to continue a healthy lifestyle in the future,” Shubrook explained.

The full study is available at To learn more about osteopathic medicine, visit

About The Journal of the American Osteopathic Association

The Journal of the American Osteopathic Association (JAOA) is the official scientific publication of the American Osteopathic Association. Edited by Robert Orenstein, DO, it is the premier scholarly peer-reviewed publication of the osteopathic medical profession. The JAOA’s mission is to advance medicine through the publication of peer-reviewed osteopathic research.


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