Long-term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes mellitus: Four-year results of the look AHEAD trial

Rena R. Wing, Judy L. Bahnson, George A. Bray, Jeanne M. Clark, Mace Coday, Caitlin Egan, Mark A. Espeland, John P. Foreyt, Edward W. Gregg, Valerie Goldman, Steven M. Haffner, Helen Hazuda, James O. Hill, Edward S. Horton, Van S. Hubbard, John Jakicic, Robert W. Jeffery, Karen C. Johnson, Steven Kahn, Tina KilleanAbbas E. Kitabchi, Cora E. Lewis, Cathy Manus, Barbara J. Maschak-Carey, Sara Michaels, Maria Montez, Brenda Montgomery, David M. Nathan, Jennifer Patricio, Anne Peters, Xavier Pi-Sunyer, Henry Pownall, David Reboussin, W. Jack Rejeski, Richard Rubin, Monika Safford, Tricia Skarphol, Brent Van Dorsten, Thomas A. Wadden, Lynne Wagenknecht, Jacqueline Wesche-Thobaben, Delia S. West, Donald Williamson, Susan Z. Yanovski

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Abstract

Background: Lifestyle interventions produce shortterm improvements in glycemia and cardiovascular disease (CVD) risk factors in individuals with type 2 diabetes mellitus, but no long-term data are available. We examined the effects of lifestyle intervention on changes in weight, fitness, and CVD risk factors during a 4-year study. Methods: The Look AHEAD (Action for Health in Diabetes) trial is a multicenter randomized clinical trial comparing the effects of an intensive lifestyle intervention (ILI) and diabetes support and education (DSE; the control group) on the incidence of major CVD events in 5145 overweight or obese individuals (59.5% female; mean age, 58.7 years) with type 2 diabetes mellitus. More than 93% of participants provided outcomes data at each annual assessment. Results: Averaged across 4 years, ILI participants had a greater percentage of weight loss than DSE participants (-6.15% vs -0.88%; P < .001) and greater improvements in treadmill fitness (12.74% vs 1.96%; P < .001), hemoglobin A1c level (-0.36% vs -0.09%; P < .001), systolic (-5.33 vs -2.97 mm Hg; P < .001) and diastolic (-2.92 vs -2.48 mm Hg; P=.01) blood pressure, and levels of high-density lipoprotein cholesterol (3.67 vs 1.97 mg/dL; P < .001) and triglycerides (-25.56 vs -19.75 mg/dL; P < .001). Reductions in low-density lipoprotein cholesterol levels were greater in DSE than ILI participants (-11.27 vs -12.84 mg/dL; P=.009) owing to greater use of medications to lower lipid levels in the DSE group. At 4 years, ILI participants maintained greater improvements than DSE participants in weight, fitness, hemoglobin A1c levels, systolic blood pressure, and highdensity lipoprotein cholesterol levels. Conclusions: Intensive lifestyle intervention can produce sustained weight loss and improvements in fitness, glycemic control, and CVD risk factors in individuals with type 2 diabetes. Whether these differences in risk factors translate to reduction in CVD events will ultimately be addressed by the Look AHEAD trial. Trial Registration: clinicaltrials.gov Identifier: NCT00017953

Original languageEnglish (US)
Pages (from-to)1566-1575
Number of pages10
JournalArchives of Internal Medicine
Volume170
Issue number17
DOIs
StatePublished - Sep 27 2010

ASJC Scopus subject areas

  • Internal Medicine

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    Wing, R. R., Bahnson, J. L., Bray, G. A., Clark, J. M., Coday, M., Egan, C., Espeland, M. A., Foreyt, J. P., Gregg, E. W., Goldman, V., Haffner, S. M., Hazuda, H., Hill, J. O., Horton, E. S., Hubbard, V. S., Jakicic, J., Jeffery, R. W., Johnson, K. C., Kahn, S., ... Yanovski, S. Z. (2010). Long-term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes mellitus: Four-year results of the look AHEAD trial. Archives of Internal Medicine, 170(17), 1566-1575. https://doi.org/10.1001/archinternmed.2010.334