ABSTRACT: BACKGROUND: Most persons with type 2 diabetes are overweight and obesity worsens the metabolic and physiologic abnormalities associated with diabetes. OBJECTIVE: The objective of this review is to assess the effectiveness of lifestyle and behavioral weight loss and weight control interventions for adults with type 2 diabetes. METHODS: Search methods: Studies were obtained from computerized searches of multiple electronic bibliographic databases, supplemented with hand searches of selected journals and consultation with experts in obesity research. Selection criteria: Studies were included if they were published or unpublished randomized controlled trials in any language, and examined weight loss or weight control strategies using one or more dietary, physical activity, or behavioral interventions, with a follow-up interval of at least 12 months. Data collection and analysis: Effects were combined using a random effects model. MAIN RESULTS: The 22 studies of weight loss interventions identified had a 4,659 participants and follow-up of 1 to 5 years. The pooled weight loss for any intervention in comparison to usual care among 585 subjects was 1.7 kg (95 % confidence interval [CI] 0.3 to 3.2), or 3.1% of baseline body weight among 517 subjects. Other main comparisons demonstrated non significant results: among 126 persons receiving a physical activity and behavioral intervention, those who also received a very low calorie diet lost 3.0 kg (95% CI -0.5 to 6.4), or 1.6% of baseline body weight, more than persons receiving a low-calorie diet. Among 53 persons receiving identical dietary and behavioral interventions, those receiving more intense physical activity interventions lost 3.9 kg (95% CI -1.9 to 9.7), or 3.6% of baseline body weight, more than those receiving a less intense or no physical activity intervention. Comparison groups often achieved significant weight loss (up to 10.0 kg), minimizing between-group differences. Changes in glycated hemoglobin generally corresponded to changes in weight and were not significant when between-group differences were examined. No data were identified on quality of life and mortality. AUTHORS CONCLUSIONS: Weight loss strategies using dietary, physical activity, or behavioral interventions produced small between-group improvements in weight. These results were minimized by weight loss in the comparison group, however, and examination of individual study arms revealed that multicomponent interventions including very low calorie diets or low calorie diets may hold promise for achieving weight loss in adults with type 2 diabetes.

OBJETIVE: To examine the relationship between access to health care and undiagnosed diabetes among the high-risk, vulnerable population in the border region between the United States of America and Mexico. METHODS: Using survey and fasting plasma glucose data from Phase I of the U.S.-Mexico Border Diabetes Prevention and Control Project (February 2001 to October 2002), this epidemiological study identified 178 adults 18-64 years old with undiagnosed diabetes, 326 with diagnosed diabetes, and 2 966 without diabetes. Access to health care among that sample (n = 3 470), was assessed by type of health insurance coverage (including "none"), number of health care visits over the past year, routine pattern of health care utilization, and country of residence. RESULTS: People with diabetes who had no insurance and no place to go for routine health care were more likely to be undiagnosed than those with insurance and a place for routine health care (odds ratio [OR] 2.6, 95% confidence interval [CI] 1.0-6.6, and OR 4.5, 95% CI 1.4-14.1, respectively). When stratified by country, the survey data showed that on the U.S. side of the border there were more people with undiagnosed diabetes if they were 1) uninsured versus the insured (28.9%, 95% CI 11.5%-46.3%, versus 9.1%, 95% CI 1.5%-16.7%, respectively) and if they 2) had made no visits or 1-3 visits to a health care facility in the past year versus had made > 4 visits (40.8%, 95% CI 19.6%-62.0%, and 23.4%, 95% CI 9.9%-36.9%, respectively, versus 2.4%, 95% CI -0.9%-5.7%) (all, P < 0.05). No similar pattern was found in Mexico. CONCLUSIONS: Limited access to health care-especially not having health insurance and/or not having a place to receive routine health services-was significantly associated with undiagnosed diabetes in the U.S.-Mexico border region.

OBJETIVO: Examinar la relación entre el acceso a la atención de salud y la diabetes no diagnosticada en la población de alto riesgo y vulnerable de la zona fronteriza entre México y los Estados Unidos. MÉTODOS: Mediante el uso de los datos de la encuesta y de la glucosa plasmática en ayunas de la fase I del Proyecto de Prevención y Control de la Diabetes en la Frontera México-Estados Unidos (de febrero del 2001 a octubre del 2002), en este estudio epidemiológico se identificaron 178 adultos de 18 a 64 años con diabetes no diagnosticada, 326 con diabetes diagnosticada y 2 966 sin diabetes. Se evaluó el acceso a la atención de salud en dicha muestra (n = 3 470), mediante el tipo de cobertura del seguro de salud (incluida "ninguna"), el número de consultas de atención de salud en el último año, las características de utilización de los servicios de salud y el país de residencia. RESULTADOS: La probabilidad de no tener un diagnóstico fue mayor en las personas que padecían diabetes y que no tenían seguro ni ningún lugar al que acudir para recibir la atención de salud que en las que sí contaban con seguro y un lugar para recibir atención de salud (razón de momios [OR], 2,6, intervalo de confianza [IC] del 95% 1,0-6,6, y OR de 4,5, IC 95% 1,4-14,1, respectivamente). Al estratificar los datos por país, los datos de la encuesta mostraron que, en el lado estadounidense de la frontera, había un mayor número de personas con diabetes no diagnosticada si: 1) no tenían seguro, frente a los asegurados (28,9%, IC 95% 11,5%-46,3%, en comparación con el 9,1%, IC 95% 1,5%-16,7%, respectivamente), y si: 2) no habían tenido consultas o habían tenido de una a tres consultas en un centro de atención de salud en el último año, en comparación con > 4 consultas (40,8%, IC 95% 19,6%- 62,0%, y 23,4%, IC 95% 9,9%-36,9%, respectivamente, en comparación con el 2,4%, IC 95% -0,9%-5,7%) (todos, p < 0.05). No se observó una pauta parecida en México. CONCLUSIÓN: En la región fronteriza entre México y los Estados Unidos, el acceso limitado a la atención de salud, especialmente si no se cuenta con un seguro de salud o no se tiene un lugar al que acudir para recibir atención de salud, mostró una relación significativa con la diabetes no diagnosticada.