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Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes.
N Engl J Med 2013; 369(2):145-54NEJM

Abstract

BACKGROUND

Weight loss is recommended for overweight or obese patients with type 2 diabetes on the basis of short-term studies, but long-term effects on cardiovascular disease remain unknown. We examined whether an intensive lifestyle intervention for weight loss would decrease cardiovascular morbidity and mortality among such patients.

METHODS

In 16 study centers in the United States, we randomly assigned 5145 overweight or obese patients with type 2 diabetes to participate in an intensive lifestyle intervention that promoted weight loss through decreased caloric intake and increased physical activity (intervention group) or to receive diabetes support and education (control group). The primary outcome was a composite of death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for angina during a maximum follow-up of 13.5 years.

RESULTS

The trial was stopped early on the basis of a futility analysis when the median follow-up was 9.6 years. Weight loss was greater in the intervention group than in the control group throughout the study (8.6% vs. 0.7% at 1 year; 6.0% vs. 3.5% at study end). The intensive lifestyle intervention also produced greater reductions in glycated hemoglobin and greater initial improvements in fitness and all cardiovascular risk factors, except for low-density-lipoprotein cholesterol levels. The primary outcome occurred in 403 patients in the intervention group and in 418 in the control group (1.83 and 1.92 events per 100 person-years, respectively; hazard ratio in the intervention group, 0.95; 95% confidence interval, 0.83 to 1.09; P=0.51).

CONCLUSIONS

An intensive lifestyle intervention focusing on weight loss did not reduce the rate of cardiovascular events in overweight or obese adults with type 2 diabetes. (Funded by the National Institutes of Health and others; Look AHEAD ClinicalTrials.gov number, NCT00017953.).

Authors

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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

23796131

Citation

Look AHEAD Research Group, et al. "Cardiovascular Effects of Intensive Lifestyle Intervention in Type 2 Diabetes." The New England Journal of Medicine, vol. 369, no. 2, 2013, pp. 145-54.
Look AHEAD Research Group, Wing RR, Bolin P, et al. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N Engl J Med. 2013;369(2):145-54.
Wing, R. R., Bolin, P., Brancati, F. L., Bray, G. A., Clark, J. M., Coday, M., ... Yanovski, S. Z. (2013). Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. The New England Journal of Medicine, 369(2), pp. 145-54. doi:10.1056/NEJMoa1212914.
Look AHEAD Research Group, et al. Cardiovascular Effects of Intensive Lifestyle Intervention in Type 2 Diabetes. N Engl J Med. 2013 Jul 11;369(2):145-54. PubMed PMID: 23796131.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. AU - ,, AU - Wing,Rena R, AU - Bolin,Paula, AU - Brancati,Frederick L, AU - Bray,George A, AU - Clark,Jeanne M, AU - Coday,Mace, AU - Crow,Richard S, AU - Curtis,Jeffrey M, AU - Egan,Caitlin M, AU - Espeland,Mark A, AU - Evans,Mary, AU - Foreyt,John P, AU - Ghazarian,Siran, AU - Gregg,Edward W, AU - Harrison,Barbara, AU - Hazuda,Helen P, AU - Hill,James O, AU - Horton,Edward S, AU - Hubbard,Van S, AU - Jakicic,John M, AU - Jeffery,Robert W, AU - Johnson,Karen C, AU - Kahn,Steven E, AU - Kitabchi,Abbas E, AU - Knowler,William C, AU - Lewis,Cora E, AU - Maschak-Carey,Barbara J, AU - Montez,Maria G, AU - Murillo,Anne, AU - Nathan,David M, AU - Patricio,Jennifer, AU - Peters,Anne, AU - Pi-Sunyer,Xavier, AU - Pownall,Henry, AU - Reboussin,David, AU - Regensteiner,Judith G, AU - Rickman,Amy D, AU - Ryan,Donna H, AU - Safford,Monika, AU - Wadden,Thomas A, AU - Wagenknecht,Lynne E, AU - West,Delia S, AU - Williamson,David F, AU - Yanovski,Susan Z, Y1 - 2013/06/24/ PY - 2013/6/26/entrez PY - 2013/6/26/pubmed PY - 2013/7/26/medline SP - 145 EP - 54 JF - The New England journal of medicine JO - N. Engl. J. Med. VL - 369 IS - 2 N2 - BACKGROUND: Weight loss is recommended for overweight or obese patients with type 2 diabetes on the basis of short-term studies, but long-term effects on cardiovascular disease remain unknown. We examined whether an intensive lifestyle intervention for weight loss would decrease cardiovascular morbidity and mortality among such patients. METHODS: In 16 study centers in the United States, we randomly assigned 5145 overweight or obese patients with type 2 diabetes to participate in an intensive lifestyle intervention that promoted weight loss through decreased caloric intake and increased physical activity (intervention group) or to receive diabetes support and education (control group). The primary outcome was a composite of death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for angina during a maximum follow-up of 13.5 years. RESULTS: The trial was stopped early on the basis of a futility analysis when the median follow-up was 9.6 years. Weight loss was greater in the intervention group than in the control group throughout the study (8.6% vs. 0.7% at 1 year; 6.0% vs. 3.5% at study end). The intensive lifestyle intervention also produced greater reductions in glycated hemoglobin and greater initial improvements in fitness and all cardiovascular risk factors, except for low-density-lipoprotein cholesterol levels. The primary outcome occurred in 403 patients in the intervention group and in 418 in the control group (1.83 and 1.92 events per 100 person-years, respectively; hazard ratio in the intervention group, 0.95; 95% confidence interval, 0.83 to 1.09; P=0.51). CONCLUSIONS: An intensive lifestyle intervention focusing on weight loss did not reduce the rate of cardiovascular events in overweight or obese adults with type 2 diabetes. (Funded by the National Institutes of Health and others; Look AHEAD ClinicalTrials.gov number, NCT00017953.). SN - 1533-4406 UR - https://www.unboundmedicine.com/medline/citation/23796131/Cardiovascular_effects_of_intensive_lifestyle_intervention_in_type_2_diabetes_ L2 - http://www.nejm.org/doi/full/10.1056/NEJMoa1212914?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -