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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.

Abstract

BACKGROUND

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.

METHODS

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.

RESULTS

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 A(1c) 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 A(1c) levels, systolic blood pressure, and high-density lipoprotein cholesterol levels.

CONCLUSIONS

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.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT00017953.

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  • Authors+Show Affiliations

    ,

    Department of Psychiatry, The Miriam Hospital/Brown Medical School, Providence, RI 02860, USA. rwing@lifespan.org

    Source

    Archives of internal medicine 170:17 2010 Sep 27 pg 1566-75

    MeSH

    Aged
    Biomarkers
    Blood Glucose
    Blood Pressure
    Body Mass Index
    Cardiovascular Diseases
    Cholesterol, HDL
    Cholesterol, LDL
    Diabetes Complications
    Diabetes Mellitus, Type 2
    Female
    Humans
    Life Style
    Male
    Middle Aged
    Obesity
    Overweight
    Patient Education as Topic
    Physical Fitness
    Risk Factors
    Severity of Illness Index
    Time Factors
    Treatment Outcome
    Triglycerides
    United States
    Weight Loss

    Pub Type(s)

    Journal Article
    Multicenter Study
    Randomized Controlled Trial
    Research Support, N.I.H., Extramural
    Research Support, N.I.H., Intramural
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, Non-P.H.S.
    Research Support, U.S. Gov't, P.H.S.

    Language

    eng

    PubMed ID

    20876408

    Citation

    Look AHEAD Research Group, and Rena R. Wing. "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, vol. 170, no. 17, 2010, pp. 1566-75.
    Look AHEAD Research Group, Wing RR. 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. Arch Intern Med. 2010;170(17):1566-75.
    Wing, R. R. (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(17), pp. 1566-75. doi:10.1001/archinternmed.2010.334.
    Look AHEAD Research Group, Wing RR. 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. Arch Intern Med. 2010 Sep 27;170(17):1566-75. PubMed PMID: 20876408.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - 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. AU - ,, AU - Wing,Rena R, PY - 2010/9/30/entrez PY - 2010/9/30/pubmed PY - 2010/10/29/medline SP - 1566 EP - 75 JF - Archives of internal medicine JO - Arch. Intern. Med. VL - 170 IS - 17 N2 - BACKGROUND: 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. METHODS: 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. RESULTS: 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 A(1c) 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 A(1c) levels, systolic blood pressure, and high-density lipoprotein cholesterol levels. CONCLUSIONS: 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. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00017953. SN - 1538-3679 UR - https://www.unboundmedicine.com/medline/citation/20876408/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_ L2 - https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/archinternmed.2010.334 DB - PRIME DP - Unbound Medicine ER -