Agurs‐Collins 1997.

Methods	Parallel randomised controlled clinical trial (RCT) Randomisation ratio: 1:1 Superiority design
Participants	Inclusion criteria: Obese individuals of African American origin Age equal to or > 55 years; diagnosis of type 2 DM Equal to or > 120% weight standards HbA1c > 8%; ambulant No medical contraindications for exercise Exclusion criteria: not explicitly stated (but see inclusion criteria) Diagnostic criteria: by medical history
Interventions	Number of study centres: not stated Treatment before study: not stated if previous HE Intervention: weekly nutrition sessions (60 minutes) with exercise training (30 minutes) for 3 months; following 3 months on biweekly problem‐solving (90 minutes) sessions. Also 1 individual counselling session Control: 1 class on glycaemic control at 3 weeks from start; 2 letters with written information on nutrition. Participants were given the results of blood tests Provider: dietician and exercise physiotherapist with experience in working with African Americans
Outcomes	Outcomes reported in abstract of publication: Primary outcomes(s): HbA1c (hypothesis testing) Secondary outcome(s): Weight BMI Waist/hip ratio Systolic and diastolic blood pressures Lipid profile Physical activity Nutrition knowledge Dietary components
Study details	Run‐in period: not stated Study terminated before regular end: yes—stopped before target of 40 per treatment arm because of time and funding constraints
Publication details	Language of publication: English Funding: dissertation research grant, partially funded by the National Institute of Aging and the National Institutes of Health Publication status: peer review journal
Stated aim of study	Quote from publication: "The objective was to evaluate a weight loss and exercise programme designed to improve diabetes management in older African Americans"
Notes	—
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Quote from publication: "Randomization was supervised by the study statistician..." Comment: split into groups depending on medication or dietary therapy, and then "assigned randomly with 1:1 ratio within medication strata"
Allocation concealment (selection bias)	Unclear risk	Comment: no mention
Blinding of participants and personnel (performance bias) Objective outcomes	High risk	Quote from publication: "One of the authors, a registered dietician experienced in working with older African‐Americans delivered the intervention program..." Comment: participants and staff not blinded because of the nature of the study
Blinding of participants and personnel (performance bias) Subjective outcomes	High risk	Comment: not blinded
Blinding of outcome assessment (detection bias) Lab tests: Lipids, HBA1C	Unclear risk	Comment: no mention of whether laboratory staff/outcome assessors for BP were blinded
Blinding of outcome assessment (detection bias) Subjective outcomes	High risk	Comment: participants completing questionnaires unlikely to have been blinded
Incomplete outcome data (attrition bias) Objective outcomes	Unclear risk	Comment: unequal loss to follow‐up, no mention of ITT analysis
Incomplete outcome data (attrition bias) Subjective outcomes	Unclear risk	Comment: as above
Selective reporting (reporting bias)	Unclear risk	Comment: protocol not available
Other bias	Unclear risk	Comment: none