Lifestyle Intervention Beneficial in Patients with Diabetes, but Not for CV Parameters

Best weight-loss rates reported in this trial compared with any current approaches
August 2013, Vol 6 ADA 2013 Highlights
Mary Mosley

Chicago, IL—The final results of the Look AHEAD study showed that an intensive lifestyle intervention program provides a range of benefits in patients with type 2 diabetes who were overweight and obese. However, it had no impact on the primary outcome of reducing cardiovascular (CV) morbidity and mortality.

The results were presented in a special session at the 2013 American Diabetes Association annual meeting to showcase the full range of beneficial outcomes.

Look AHEAD was terminated in early October 2012 after a mean 9.6 years, because of futility. The intensive lifestyle intervention that included weight loss and moderate physical activity was compared with diabetes support and education.

“Look AHEAD showed that participants with diabetes can lose weight and maintain it,” said Rena R. Wing, PhD, Professor of Psychiatry and Human Behavior, the Warren Alpert Medical School of Brown University, Providence, RI. “This weight loss has many beneficial effects on glycemic control and on cardiovascular disease risk factors. However, it did not affect the risk of cardiovascular disease.”

The primary outcome of the first CV event—CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for angina—was reported in 403 patients in the lifestyle intervention group and in 418 patients in the education group (P = .505). No significant difference in CV event incidence was seen at any time point.

No significant difference was seen in the secondary composite outcome measures or their components. In addition, no difference was seen across the 3 prespecified subgroup comparisons of history of CV disease, sex, and race and ethnicity.

Key Benefits with Intensive Intervention
Key benefits with the intensive lifestyle intervention were:
  • Significantly improved fitness
  • Improved systolic blood pressure
  • Improved hemoglobin A1c (a significant between-group difference of 0.22 at end of trial)
  • Significant weight-loss reduction
  • A 31% reduction in advanced chronic kidney disease.

Weight loss was significantly greater with the lifestyle intervention at all time points, and was greatest at 1 year. At the end of the study, the weight-loss rates were 6.0% with intervention and 3.5% with education, and the difference across the entire study between the groups was 4%.

Dr Wing stated that weight losses achieved during Look AHEAD represent the best possible achievement with current lifestyle approaches. However, “they may not be sufficient to reduce CV events.” Furthermore, more intensive medical management of CV disease risk factors, greater use of statins, and education may have reduced the differences between the groups. Also, earlier intervention during the course of diabetes or before diabetes develops may be needed to reduce CV risk.

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Last modified: October 8, 2013
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