Cardiovascular Effects of Intensive Lifestyle Intervention in Type 2 Diabetes

Abstract

BACKGROUND Weight loss is recommended for overweight and obese individuals with type 2 diabetes based on short-term studies, but long-term effects on cardiovascular disease remain unknown. We examined whether intensive lifestyle intervention for weight loss decreased cardiovascular morbidity and mortality in overweight or obese adults with type 2 diabetes. METHODS We randomly assigned 5,145 overweight or obese individuals with type 2 diabetes recruited at 16 US centers to intensive lifestyle intervention (the intervention group), which promoted weight loss through decreased calorie intake and increased physical activity, or diabetes support and education (the control group). The primary outcome was the first post-randomization occurrence of a composite cardiovascular outcome (cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, or hospitalized angina) over a planned maximum follow-up of 13.5 years. RESULTS The trial was stopped early based on a futility analysis when median follow-up was 9.6 years. Weight loss was greater in the intervention group than the control group throughout (8.6% vs. 0.7% at 1 year; 6.0% vs. 3.5% at study end). Intensive lifestyle intervention also produced greater reductions in hemoglobin A1c and greater initial improvements in fitness and all cardiovascular risk factors, except LDL cholesterol. The primary outcome occurred in 403 patients in the intervention group and in 418 in the control group (1.83/100 person-years and 1.92/100 person-years, respectively; hazard ratio 0.95; 95% CI 0.83 to 1.09, p=0.505). CONCLUSION In our study, intensive lifestyle intervention focused on weight loss did not reduce cardiovascular events in overweight or obese adults with type 2 diabetes. (Funded by the Department of Health and Human Services and others; ClinicalTrials.gov number, NCT00017953.)

Cost of intervention delivery in a lifestyle weight loss trial in type 2 diabetes: results from the Look AHEAD clinical trial

“…As previously reported 4, the ILI in Look AHEAD produced a mean weight loss of 8.6% at year 1 and 6.0% at the end of the intervention (median of 9.6 years). This weight loss was significantly greater than the 0.7% and 3.5% weight loss in DSE at year 1 and the end of intervention, respectively.…”

“…This weight loss was significantly greater than the 0.7% and 3.5% weight loss in DSE at year 1 and the end of intervention, respectively. As noted earlier, the lifestyle intervention had a large number of both short‐term and long‐term health benefits relative to DSE 4, 5, 6, 7, 8, 9, 10. In addition, the lifestyle intervention was associated with a reduction in medical care costs, with a 10% savings related to hospitalizations and a 7% savings in medication costs.…”

“…The primary outcome was incidence of major cardiovascular events 4. Secondary outcomes included many other markers of health 15.…”

“…lifestyle intervention, reduced the risk of developing diabetes by 58% compared with a placebo intervention 3. In Look AHEAD, intensive lifestyle intervention (ILI) did not reduce cardiovascular morbidity and mortality in persons who were overweight or obese with type 2 diabetes 4, but it produced improvements in sleep apnea, incontinence and erectile dysfunction, reduced the incidence of high‐risk kidney disease and resulted in better long‐term diabetes control and some remission of diabetes, as well as fewer hospitalizations, compared with the control group 5, 6, 7, 8, 9, 10. An important concern often raised 11 is that these interventions are costly to provide: data are needed on the costs involved in offering different types of weight loss programmes.…”

Potential of electric bicycles to improve the health of people with Type 2 diabetes: a feasibility study

“…Lifestyle change, including weight loss, improves HbA 1c concentration and other cardiovascular risk factors in people with Type 2 diabetes 1, 2, 3, and can achieve remission to a non‐diabetic state, with remission closely related to the degree of weight loss 3. As well as weight loss, increasing physical activity is a target of such interventions, but success in changing activity behaviour is often limited 1, 2 and any changes are rarely maintained at initial levels 3.…”