Look AHEAD in Print: Lifestyle Intervention Improves CV Risk Factors in Type 2 Diabetes

September 29, 2010

September 29, 2010 (Chicago, Illinois)— Patients with type 2 diabetes who followed an intensive lifestyle-intervention program aimed at achieving and maintaining weight loss and fitness achieved those goals and showed significant improvements in blood pressure, glycemic control, and some lipid measures over four years, compared with a usual-care control group, in the Action for Health Diabetes (Look AHEAD) study [1]. Levels of low-density lipoprotein (LDL) cholesterol went down more in the controls, who used statins to a greater extent.

"Longer follow-up will allow us to determine whether the differences between groups in CVD [cardiovascular disease] risk factors can be maintained and whether the intensive lifestyle intervention has positive effects on cardiovascular morbidity and mortality," write the authors, led by Dr Rena R Wing (Miriam Hospital/Brown Medical School, Providence, RI), in the September 27, 2010 issue of the Archives of Internal Medicine.

The published Look AHEAD results are largely unchanged from the study's presentation at the Obesity 2009 scientific meeting, which was reported then by heartwire .

The study randomized 5145 patients with confirmed type 2 diabetes, a body-mass index >25 (>27 among those taking insulin), blood pressure <160/100 mm Hg, and triglycerides <600 mg/dL to following an intensive lifestyle-modification program or to receive usual-care diabetes support and education.

The intensive program including diet modification, exercise, behavioral training, and group support with in-person and telephone follow-ups, all designed to achieve 7% weight loss at one year and to keep the weight off.

Change in Weight, Fitness, And Cardiovascular Risk Factors Averaged Over Four Years, Intensive Lifestyle Intervention vs Standard Diabetes Support and Education

Parameter Lifestyle intervention, n=2570 Support and education, n=2575 p
Weight loss (%) −6.15 −0.88 <0.001
Treadmill fitness (% METS) 12.74 1.96 <0.001
Hemoglobin A1c (%) −0.36 −0.09 <0.001
Systolic pressure (mm Hg) −5.33 −2.97 <0.001
Diastolic pressure (mm Hg) −2.92 −2.48 <0.01
HDL-C (mg/dL) 3.67 1.97 <0.001
Triglycerides (mg/dL) −25.56 −19.75 <0.001

"Although the differences between the two groups were greatest initially and decreased over time for several measures, the differences between the groups averaged across the four years were substantial and indicate that the intensive lifestyle-intervention group spent a considerable time at lower CVD risk," the group writes.

An accompanying editorial from Dr Prakash C Deedwania (Veterans Affairs Central California Healthcare System and University of California San Francisco, Fresno) describes the theme he sees as emerging from Look AHEAD [2]: "Simple established approaches based on conventional wisdom work well, and there is no need to rush to newer or novel approaches unless convincing evidence supports such a move. In our efforts to deal with major public health-issues such as overweight and obesity, type 2 diabetes, and cardiovascular disease, it is prudent to return to basics," he writes.

Look AHEAD was sponsored by the National Institutes of Health. Coauthor Dr John M Jakicic (University of Pittsburgh, PA) reports receiving grant/research support from BodyMedia; receiving consulting fees from BodyMedia, UPMC Health Plan, and Proctor & Gamble; and serving on a scientific advisory committee for Free & Clear. Deedwania had no disclosures.

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