Finally, there may have been changes in other medical
or self-management behaviors that were not evaluated
which may have contributed to the improvements. For
example, although subjects were not instructed to adopt a
formal exercise program, and thus daily exercise was not
tracked, it is possible that many did increase regular
physical activity after receiving education. In addition,
because this was an un-blinded study in a worksite setting,
it is possible that individuals in the Intervention Group
shared information amongst co-workers that could have
affected some of the study endpoints. Another possible
factor affecting the observed changes could have been
changes to diabetes medications. A review of subject records
for the Intervention Group revealed that n=22 (or
22%) of participants had a decreased need for antihyperglycemic
medications (frequency, number or dose)
during the 24 week intervention. In contrast, only n=7 (or
7%) had an increased need for anti-hyperglycemic medications.
Thus, it is unlikely that an increase in medications
contributed substantially to the average reductions in
HbA1c in the Intervention Group. Due to the nature of the
study design, detailed information on medication usage
during the study was not collected from the Reference
Group participants.