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United States Department of Agriculture

Agricultural Research Service

Research Project: Dietary Guidelines Adherence and Healthy Body Weight Maintenance Title: Lifestyle change and mobility in obese adults with type 2 diabetes

Authors
item Rejeski, W -
item Ip, Edward -
item Bertoni, Alan -
item Bray, George -
item Evans, Gina -
item Gregg, Edward -
item Zhang, Qiang -
item Raatz, Susan

Submitted to: New England Journal of Medicine
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: March 29, 2012
Publication Date: April 4, 2012
Citation: Rejeski, W.J., Ip, E.H., Bertoni, A.G., Bray, G.A., Evans, G., Gregg, E.W., Zhang, Q., Raatz, S.K. 2012. Lifestyle change and mobility in obese adults with type 2 diabetes. New England Journal of Medicine. 366::1209-1217.

Interpretive Summary: Adults with type 2 diabetes mellitus often have limitations in mobility that increase with age. Weight loss and improved fitness could slow the loss of mobility in such patients. We randomly assigned 5145 overweight or obese adults between the ages of 45 and 74 years with type 2 diabetes to either an intensive lifestyle intervention or a diabetes support-and-education program and 5016 participants contributed data. The primary outcome was self-reported limitation in mobility, with annual assessments for 4 years. At year 4, 20.6% of the participants in the lifestyle-intervention group had severe disability and 38.5% had good mobility; the participants in the support group were 26.2% severely disabled and 31.9% had good mobility. The lifestyle-intervention group had 48% reduction in the risk of loss of mobility, as compared with the support group Both weight loss and improved were significant mediators of this effect. Weight loss and improved fitness slowed the decline in mobility in overweight adults with type 2 diabetes.

Technical Abstract: Background Adults with type 2 diabetes mellitus often have limitations in mobility that increase with age. An intensive lifestyle intervention that produces weight loss and improves fitness could slow the loss of mobility in such patients. Methods We randomly assigned 5145 overweight or obese adults between the ages of 45 and 74 years with type 2 diabetes to either an intensive lifestyle intervention or a diabetes support-and-education program; 5016 participants contributed data. We used hidden Markov models to characterize disability states and mixed-effects ordinal logistic regression to estimate the probability of functional decline. The primary outcome was self-reported limitation in mobility, with annual assessments for 4 years. Results At year 4, among 2514 adults in the lifestyle-intervention group, 517 (20.6%) had severe disability and 969 (38.5%) had good mobility; the numbers among 2502 participants in the support group were 656 (26.2%) and 798 (31.9%), respectively. The lifestyle-intervention group had a relative reduction of 48% in the risk of loss of mobility, as compared with the support group (odds ratio, 0.52; 95% confidence interval, 0.44 to 0.63; P<0.001). Both weight loss and improved fitness (as assessed on treadmill testing) were significant mediators of this effect (P<0.001 for both variables). Adverse events that were related to the lifestyle intervention included a slightly higher frequency of musculoskeletal symptoms at year 1. Conclusions Weight loss and improved fitness slowed the decline in mobility in overweight adults with type 2 diabetes. (Funded by the Department of Health and Human Services and others; ClinicalTrials.gov number, NCT00017953.)

Last Modified: 10/21/2014