If obese/overweight patients with diabetes Type 2 are helped to get fit, lose weight and control blood glucose levels, their long-term outlook improves significantly, according to a report published in Archives of Internal Medicine. Addressing cardiovascular risk factors and blood glucose control is vital in preventing the long-term complications that are linked to diabetes Type 2, especially if the patient is obese when diagnosed with the disease.
The focus has often been on screening and managing diabetes with medications. As background information, the authors write:
Lifestyle-based weight loss interventions are also recommended to improve glycemic control and risk factors, but the evidence supporting the efficacy of lifestyle approaches is limited to short-term studies of typically less than one year.
The investigators, from the Look AHEAD (Action for Health in Diabetes) Research Group, carried out a multicenter, randomized clinical trial which compared the effects of an intensive lifestyle intervention versus diabetes support and education. The study involved 5,145 obese/overweight people with diabetes Type 2 – their average age was 58.7 years.
- Lifestyle intervention group – 2,570 of them were assigned to a combination of special diet and physical activity. The aim was to get them to lose 7% of their body weight within 12 months – and to keep the weight off for a period of four years. They were contacted by phone and/or seen at least once a month throughout the 48-month period.
- Diabetes support group – 2,575 of them received diabetes support and education. They were encouraged to attend three group sessions annually – these sessions focused on such themes as diet, social support and physical activity.
The researchers reveal that those in the intervention group lost an average of 6.2% of their body weight within twelve months, compared to just 0.9% in the support group.
Those in the intervention group attained much better levels of fitness, hemoglobin A1c levels (blood glucose measure), levels of HDL (good cholesterol) and blood pressure than the participants in the support group.
However, LDL (bad cholesterol) levels dropped further in the support group – the authors say this was because of the cholesterol-lowering medications they received.
At the end of the four years, those in the intervention group had better improvements in fitness, body weight, blood glucose levels, systolic blood pressure and levels of HDL.
The authors wrote:
Although the differences between the two groups were greatest initially and decreased over time for several measures, the differences between the groups averaged across the four years were substantial and indicate that the intensive lifestyle intervention group spent a considerable time at lower cardiovascular disease risk.
The critical question is whether the differences between groups in risk factors will translate into differences in the development of cardiovascular disease. These results will not be available for several additional years. However, effects of the magnitude that we observed for fitness, HDL-C and hemoglobin A1c levels and blood pressure have been associated with decreased cardiovascular events and mortality in previous medication trials and observational studies. Moreover, there may be long-term beneficial effects from the four-year period in which intensive lifestyle intervention participants have been exposed to lower cardiovascular disease risk factors, as seen in other clinical trials.
Four-Year Results of the Look AHEAD Trial – The Look AHEAD Research Group
Arch Intern Med. 2010;170(17):1566-1575. doi:10.1001/archinternmed.2010.334
Written by Christian Nordqvist