COMMENTARY

Anne Peters: The Year in Diabetes

Anne L. Peters, MD; Mark Harmel, MPH

Disclosures

December 10, 2013

In This Article

Look AHEAD Halted

The Look AHEAD trial examined the benefits of weight loss and exercise in the treatment of type 2 diabetes. These basic recommendations have been around forever, but they have never been tested in a long-running trial until recently, and the standard for success was set very high.

The primary outcome was a composite of macrovascular events, including death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for angina. The trial was stopped because the intervention did not reduce rates of cardiovascular events in overweight or obese adults with type 2 diabetes after 11 years.[24]

This study consisted of 5145 adults with type 2 diabetes who had a mean body mass index > 35 kg/m2 who were randomly assigned to the intensive lifestyle arm, which promotes weight loss through diet and exercise, or the diabetes support and education arm (control group), which met twice a year.

The intensive lifestyle group had an 8.6% reduction in body weight in the first year, with an increase in physical fitness. Weight loss reverted to only about 5%, but that was maintained through the duration of the 11-year trial, and this led to many other benefits during the early years of the trial. These included reductions in urinary incontinence, sleep apnea, depression, and medication use, along with improvements in quality of life, physical functioning, and mobility.

As one of the principal investigators in the trial, my take-away advice for patients is that there are real benefits to lifestyle change, and we now know that we can create intensive diet and exercise interventions that do no harm and can safely reduce the burden of diabetes. Look AHEAD will now continue as a cohort study, and the patients will be followed over time. Much more data will be forthcoming that will add to our understanding about the trial.

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