COMMENTARY

Weight Loss and Diabetes

Brianne N. Hobbs, OD

Disclosures

November 12, 2013

Cardiovascular Effects of Intensive Lifestyle Modification in Type 2 Diabetes

Look AHEAD Research Group, Wing RR, Bolin P, et al
N Engl J Med. 2013;369:145-154

Study Summary

"Lose weight." "Exercise more." "Eat less."

Long have these words been the standard mantras issued to overweight patients with diabetes; however, these are not easy directions to follow. The emotional concerns of the patient with diabetes, such as the fear of blindness or amputation, coupled with the physical demands of modifying diet, attending numerous medical appointments, and the disease itself, are a testament to the difficulty of diabetes.

Although patients are often encouraged to make lifestyle modifications, questions remain about the true long-term effects of such strategies as intensive weight loss. The Look AHEAD study focused on further describing the relationship between lifestyle intervention and the enduring effects on disease progression.

This study investigated the sustained impact of intensive weight loss on cardiovascular morbidity and mortality in overweight patients with type 2 diabetes. This was a multicenter randomized, controlled trial that enrolled 5145 patients at 16 sites across the United States. Inclusion criteria were age 45-75 years, a body mass index > 25 kg/m2, and an A1c level of 11% or less.

Patients were randomly assigned to an intensive weight loss group or the control group. The intensive weight loss group aimed to achieve a weight reduction of 7% by combining physical activity with reduced caloric intake. The control group received only diabetes support and education, with no targeted weight loss.

After a median follow-up of 9.5 years, there were 403 cardiovascular events in the intensive group compared with 418 events in the control group (hazard ratio, 0.95). There was no statistically significant difference in cardiac outcomes between the groups (P = .51; 95% confidence interval, 0.83-1.09), and the trial was concluded prematurely as a result of futility analysis.

Secondary outcome measures, such as A1c levels and cardiovascular fitness, were significantly better in the intensive intervention group, providing evidence that there were important benefits associated with weight loss. Overall, the study concluded that there was no difference in cardiovascular morbidity and mortality in the intensive weight loss group compared with the control group.

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