|Foreyt, John -|
Submitted to: Archives of Internal Medicine
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: May 4, 2010
Publication Date: September 27, 2010
Citation: The Look AHEAD Research Group. 2010. Long-term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes mellitus: Four-year results of the Look AHEAD trial. Archives of Internal Medicine. 170:1566-1575. Interpretive Summary: Improving glycemic control and cardiovascular disease (CVD) risk factors in individuals with type 2 diabetes mellitus (DM) is critical for preventing long-term vascular complications of this disease. This has led to increased emphasis on screening and pharmacologic management of these risk factors. Lifestyle-based weight loss interventions are also recommended to improve glycemic control and CVD risk factors. This study examined the effects of a long-term, multidisciplinary lifestyle intervention and assessed the long-term viability of lifestyle intervention as a clinical and public health strategy for obesity and type 2 DM. Our results indicated that across the 4 years, participants in the intensive lifestyle intervention experienced significantly greater improvements in sustained weight loss, fitness, cholesterol levels, systolic blood pressure, and hemoglobin A1c, which is a measure of glycemic control, than those in a diabetes support and education group. These findings are impressive because medications typically affect only one risk factor, while this lifestyle intervention produced positive results in multiple measures simultaneously.
Technical Abstract: Lifestyle interventions produce short-term improvements in glycemia and cardiovascular disease (CVD) risk factors in individuals with type 2 diabetes mellitus, but no long-term data are available. We examined the effects of lifestyle intervention on changes in weight, fitness, and CVD risk factors during a 4-year study. The Look AHEAD (Action for Health in Diabetes) trial is a multicenter randomized clinical trial comparing the effects of an intensive lifestyle intervention (ILI) and diabetes support and education (DSE; the control group) on the incidence of major CVD events in 5145 overweight or obese individuals (59.5% female; mean age, 58.7 years) with type 2 diabetes mellitus. More than 93% of participants provided outcomes data at each annual assessment. Averaged across 4 years, ILI participants had a greater percentage of weight loss than DSE participants (–6.15% vs –0.88%; P < .001) and greater improvements in treadmill fitness (12.74% vs 1.96%; P < .001), hemoglobin A1c level (–0.36% vs –0.09%; P < .001), systolic (–5.33 vs –2.97 mm Hg; P < .001) and diastolic (–2.92 vs –2.48 mm Hg; P = .01) blood pressure, and levels of high-density lipoprotein cholesterol (3.67 vs 1.97 mg/dL; P < .001) and triglycerides (–25.56 vs –19.75 mg/dL; P < .001). Reductions in low-density lipoprotein cholesterol levels were greater in DSE than ILI participants (–11.27 vs –12.84 mg/dL; P = .009) owing to greater use of medications to lower lipid levels in the DSE group. At 4 years, ILI participants maintained greater improvements than DSE participants in weight, fitness, hemoglobin A1c levels, systolic blood pressure, and high-density lipoprotein cholesterol levels. Intensive lifestyle intervention can produce sustained weight loss and improvements in fitness, glycemic control, and CVD risk factors in individuals with type 2 diabetes. Whether these differences in risk factors translate to reduction in CVD events will ultimately be addressed by the Look AHEAD trial.