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, Mathilda 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 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

Research output: Contribution to journalArticle

761 Citations (Scopus)

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

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Type 2 Diabetes Mellitus
Life Style
Weights and Measures
Cardiovascular Diseases
Health
Blood Pressure
Weight Loss
Hemoglobins
LDL Cholesterol
HDL Cholesterol
Triglycerides
Randomized Controlled Trials
Lipids
Education
Control Groups
Incidence

All Science Journal Classification (ASJC) codes

  • Internal Medicine

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

In: Archives of Internal Medicine, Vol. 170, No. 17, 27.09.2010, p. 1566-1575.

Research output: Contribution to journalArticle

Wing, RR, Bahnson, JL, Bray, GA, Clark, JM, Coday, M, Egan, C, Espeland, MA, Foreyt, JP, Gregg, EW, Goldman, V, Haffner, SM, Hazuda, H, Hill, JO, Horton, ES, Hubbard, VS, Jakicic, J, Jeffery, RW, Johnson, K, Kahn, S, Killean, T, Kitabchi, AE, Lewis, CE, Manus, C, Maschak-Carey, BJ, Michaels, S, Montez, M, Montgomery, B, Nathan, DM, Patricio, J, Peters, A, Pi-Sunyer, X, Pownall, H, Reboussin, D, Rejeski, WJ, Rubin, R, Safford, M, Skarphol, T, Van Dorsten, B, Wadden, TA, Wagenknecht, L, Wesche-Thobaben, J, West, DS, Williamson, D & Yanovski, SZ 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, vol. 170, no. 17, pp. 1566-1575. https://doi.org/10.1001/archinternmed.2010.334
Wing, Rena R. ; Bahnson, Judy L. ; Bray, George A. ; Clark, Jeanne M. ; Coday, Mathilda ; Egan, Caitlin ; Espeland, Mark A. ; Foreyt, John P. ; Gregg, Edward W. ; Goldman, Valerie ; Haffner, Steven M. ; Hazuda, Helen ; Hill, James O. ; Horton, Edward S. ; Hubbard, Van S. ; Jakicic, John ; Jeffery, Robert W. ; Johnson, Karen ; Kahn, Steven ; Killean, Tina ; Kitabchi, Abbas E. ; Lewis, Cora E. ; Manus, Cathy ; Maschak-Carey, Barbara J. ; Michaels, Sara ; Montez, Maria ; Montgomery, Brenda ; Nathan, David M. ; Patricio, Jennifer ; Peters, Anne ; Pi-Sunyer, Xavier ; Pownall, Henry ; Reboussin, David ; Rejeski, W. Jack ; Rubin, Richard ; Safford, Monika ; Skarphol, Tricia ; Van Dorsten, Brent ; Wadden, Thomas A. ; Wagenknecht, Lynne ; Wesche-Thobaben, Jacqueline ; West, Delia S. ; Williamson, Donald ; Yanovski, Susan Z. / 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. In: Archives of Internal Medicine. 2010 ; Vol. 170, No. 17. pp. 1566-1575.
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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",
author = "Wing, {Rena R.} and Bahnson, {Judy L.} and Bray, {George A.} and Clark, {Jeanne M.} and Mathilda Coday and Caitlin Egan and Espeland, {Mark A.} and Foreyt, {John P.} and Gregg, {Edward W.} and Valerie Goldman and Haffner, {Steven M.} and Helen Hazuda and Hill, {James O.} and Horton, {Edward S.} and Hubbard, {Van S.} and John Jakicic and Jeffery, {Robert W.} and Karen Johnson and Steven Kahn and Tina Killean and Kitabchi, {Abbas E.} and Lewis, {Cora E.} and Cathy Manus and Maschak-Carey, {Barbara J.} and Sara Michaels and Maria Montez and Brenda Montgomery and Nathan, {David M.} and Jennifer Patricio and Anne Peters and Xavier Pi-Sunyer and Henry Pownall and David Reboussin and Rejeski, {W. Jack} and Richard Rubin and Monika Safford and Tricia Skarphol and {Van Dorsten}, Brent and Wadden, {Thomas A.} and Lynne Wagenknecht and Jacqueline Wesche-Thobaben and West, {Delia S.} and Donald Williamson and Yanovski, {Susan Z.}",
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TY - JOUR

T1 - Long-term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes mellitus

T2 - Four-year results of the look AHEAD trial

AU - Wing, Rena R.

AU - Bahnson, Judy L.

AU - Bray, George A.

AU - Clark, Jeanne M.

AU - Coday, Mathilda

AU - Egan, Caitlin

AU - Espeland, Mark A.

AU - Foreyt, John P.

AU - Gregg, Edward W.

AU - Goldman, Valerie

AU - Haffner, Steven M.

AU - Hazuda, Helen

AU - Hill, James O.

AU - Horton, Edward S.

AU - Hubbard, Van S.

AU - Jakicic, John

AU - Jeffery, Robert W.

AU - Johnson, Karen

AU - Kahn, Steven

AU - Killean, Tina

AU - Kitabchi, Abbas E.

AU - Lewis, Cora E.

AU - Manus, Cathy

AU - Maschak-Carey, Barbara J.

AU - Michaels, Sara

AU - Montez, Maria

AU - Montgomery, Brenda

AU - Nathan, David M.

AU - Patricio, Jennifer

AU - Peters, Anne

AU - Pi-Sunyer, Xavier

AU - Pownall, Henry

AU - Reboussin, David

AU - Rejeski, W. Jack

AU - Rubin, Richard

AU - Safford, Monika

AU - Skarphol, Tricia

AU - Van Dorsten, Brent

AU - Wadden, Thomas A.

AU - Wagenknecht, Lynne

AU - Wesche-Thobaben, Jacqueline

AU - West, Delia S.

AU - Williamson, Donald

AU - Yanovski, Susan Z.

PY - 2010/9/27

Y1 - 2010/9/27

N2 - 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

AB - 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

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