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Lifestyle Intervention Yields Numerous Health Benefits for People with Type 2 Diabetes, According To National Trial Led By Miriam Researcher

6/25/2013

However, intervention did not reduce cardiovascular events in obese adults with type 2 diabetes  


New research suggests a long-term, intensive lifestyle intervention program that promotes weight loss can yield significant health benefits for obese individuals with type 2 diabetes. The Look AHEAD (Action for Health in Diabetes) clinical trial, led by Rena R. Wing, Ph.D., director of the Weight Control and Diabetes Research Center at The Miriam Hospital, found the intervention improved quality of life, reduced microvascular complications such as nephropathy, lowered the risk of depression and lowered medical costs by reducing the need for hospitalizations, outpatient care and medications.

However, the intervention was no more successful in reducing the risk for heart attacks or strokes when compared to a similar program that only provided diabetes support and education. The overall findings were presented on Monday, June 24 at the American Diabetes Association’s 73rd Scientific Sessions; the research involving the cardiovascular risk specifically was published online by the New England Journal of Medicine.

“Although the intensive lifestyle intervention did not have the results we expected, the findings of the Look AHEAD trial do reinforce the overall health benefits of modest weight loss, particularly for obese individuals with type 2 diabetes,” said Wing, who is also a professor of psychiatry and human behavior at The Warren Alpert Medical School of Brown University.

Standing on a ScaleLook AHEAD is a two-armed randomized trial conducted in 16 centers across the United States, with more than 5,000 overweight or obese adults aged 45-76 years diagnosed with type 2 diabetes. Funded by the National Institutes of Health, the study assigned participants to one of two interventions: lifestyle (involving physical activity and a weight loss of at least 7 percent), or diabetes support and education (involving three counseling sessions per year on nutrition, physical activity, and social support).

Participants were followed for up to 11.5 years, with an average follow-up of 9.6 years at the time the intervention ended. The primary goal was to determine whether the intensive intervention would reduce the risk of cardiovascular mortality and morbidity.

Overall, participants in the intensive lifestyle intervention group initially lost 8.6 percent of body weight and maintained a loss of 6 percent of body weight at the end of intervention, which was better than researchers expected. However, the intensive lifestyle group did not reduce their risk of cardiovascular morbidity or mortality or the level of LDL (or “bad”) cholesterol, compared to the group that received diabetes support and education. The support and education group lost 0.7 percent of body weight initially and 3.5 percent at the end of intervention.

Wing said there were numerous possible explanations for the unexpected results, including the greater use of medications to lower LDL cholesterol in the comparison condition, which may have minimized any difference between the groups. Researchers also cannot rule out the possibility that greater weight losses might impact cardiovascular risk.

However, the intensive lifestyle intervention group did experience other benefits when compared to those in the comparison group, including diabetes control and microvascular complications, depression and quality of life, and health care costs and utilization. Lifestyle intervention also produced greater reductions in hemoglobin A1C (or blood glucose) and greater initial improvements in fitness and all CVD risk factors except LDL cholesterol.