Rena R Wing, Paula Bolin, Frederick L Brancati, George A Bray, Jeanne M Clark, Mace Coday, Richard S Crow, Jeffrey M Curtis, Caitlin M Egan, Mark A Espeland, Mary Evans, John P Foreyt, Siran Ghazarian, Edward W Gregg, Barbara Harrison, Helen P Hazuda, James O Hill, Edward S Horton, Van S Hubbard, John M Jakicic, Robert W Jeffery, Karen C Johnson, Steven E Kahn, Abbas E Kitabchi, William C Knowler, Cora E Lewis, Barbara J Maschak-Carey, Maria G Montez, Anne Murillo, David M Nathan, Jennifer Patricio, Anne Peters, Xavier Pi-Sunyer, Henry Pownall, David Reboussin, Judith G Regensteiner, Amy D Rickman, Donna H Ryan, Monika Safford, Thomas A Wadden, Lynne E Wagenknecht, Delia S West, David F Williamson, Susan Z Yanovski
Journal: The New England journal of medicine 2013;369(2):145-54
PMID: 23796131
Weight loss is recommended for overweight or obese patients with type 2 diabetes as it increases glycaemic control, reduces risk factors of cardiovascular disease and improves overall quality of life. These benefits, however, are based on short-term studies and the long-term effects of weight loss in this population have not been examined. The aim of this randomised trial was to elucidate whether an intensive lifestyle intervention of weight loss and increased physical activity would decrease cardiovascular morbidity and mortality in overweight or obese adults with type 2 diabetes. Participants were either assigned to an intervention group receiving diet and exercise counselling, or a control group receiving diabetes support and education. A total of 5145 patients were enrolled in the study and the median follow-up was nearly 10 years. The findings of this study showed that an intensive lifestyle intervention did not reduce the risk of cardiovascular morbidity and mortality, as compared with a control programme of diabetes support and education, among overweight and obese patients. While this primary outcome was not reduced, participants in the intervention group experienced various clinically beneficial outcomes throughout the follow-up period.
BACKGROUND
Weight loss is recommended for overweight or obese patients with type 2 diabetes on the basis of short-term studies, but long-term effects on cardiovascular disease remain unknown. We examined whether an intensive lifestyle intervention for weight loss would decrease cardiovascular morbidity and mortality among such patients.
METHODS
In 16 study centers in the United States, we randomly assigned 5145 overweight or obese patients with type 2 diabetes to participate in an intensive lifestyle intervention that promoted weight loss through decreased caloric intake and increased physical activity (intervention group) or to receive diabetes support and education (control group). The primary outcome was a composite of death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for angina during a maximum follow-up of 13.5 years.
RESULTS
The trial was stopped early on the basis of a futility analysis when the median follow-up was 9.6 years. Weight loss was greater in the intervention group than in the control group throughout the study (8.6% vs. 0.7% at 1 year; 6.0% vs. 3.5% at study end). The intensive lifestyle intervention also produced greater reductions in glycated hemoglobin and greater initial improvements in fitness and all cardiovascular risk factors, except for low-density-lipoprotein cholesterol levels. The primary outcome occurred in 403 patients in the intervention group and in 418 in the control group (1.83 and 1.92 events per 100 person-years, respectively; hazard ratio in the intervention group, 0.95; 95% confidence interval, 0.83 to 1.09; P=0.51).
CONCLUSIONS
An intensive lifestyle intervention focusing on weight loss did not reduce the rate of cardiovascular events in overweight or obese adults with type 2 diabetes. (Funded by the National Institutes of Health and others; Look AHEAD ClinicalTrials.gov number, NCT00017953.).
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