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; Mace 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 C. Johnson; Steven Kahn; Tina Killean; Abbas 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

doi:10.1001/archinternmed.2010.334

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, Mace 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 C. 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

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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 A_1c 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 A_1c 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 language	English (US)
Pages (from-to)	1566-1575
Number of pages	10
Journal	Archives of Internal Medicine
Volume	170
Issue number	17
DOIs	https://doi.org/10.1001/archinternmed.2010.334
State	Published - Sep 27 2010

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Wing, R. R., Bahnson, J. L., Bray, G. A., Clark, J. M., Coday, M., Egan, C., Espeland, M. A., Foreyt, J. P., Gregg, E. W., Goldman, V., Haffner, S. M., Hazuda, H., Hill, J. O., Horton, E. S., Hubbard, V. S., Jakicic, J., Jeffery, R. W., Johnson, K. C., Kahn, S., ... Yanovski, S. Z. (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, 170(17), 1566-1575. https://doi.org/10.1001/archinternmed.2010.334

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

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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, KC, 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

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title = "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",

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 Mace 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 Johnson, {Karen C.} 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.}",

year = "2010",

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doi = "10.1001/archinternmed.2010.334",

language = "English (US)",

volume = "170",

pages = "1566--1575",

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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, Mace

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 C.

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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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

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