Document Detail


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.
MedLine Citation:
PMID:  20876408     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Lifestyle interventions produce short-term 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 high-density 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.
Authors:
; Rena R Wing
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Publication Detail:
Type:  Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, N.I.H., Extramural; Research Support, N.I.H., Intramural; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, Non-P.H.S.; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Archives of internal medicine     Volume:  170     ISSN:  1538-3679     ISO Abbreviation:  Arch. Intern. Med.     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-09-29     Completed Date:  2010-10-28     Revised Date:  2011-07-28    
Medline Journal Info:
Nlm Unique ID:  0372440     Medline TA:  Arch Intern Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1566-75     Citation Subset:  AIM; IM    
Affiliation:
Department of Psychiatry, The Miriam Hospital/Brown Medical School, Providence, RI 02860, USA. rwing@lifespan.org
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00017953
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MeSH Terms
Descriptor/Qualifier:
Aged
Biological Markers / blood
Blood Glucose / metabolism
Blood Pressure
Body Mass Index
Cardiovascular Diseases / etiology,  prevention & control*
Cholesterol, HDL / blood
Cholesterol, LDL / blood
Diabetes Complications / prevention & control*
Diabetes Mellitus, Type 2 / blood,  complications,  rehabilitation*
Female
Humans
Life Style*
Male
Middle Aged
Obesity / rehabilitation*
Overweight / rehabilitation
Patient Education as Topic*
Physical Fitness*
Risk Factors
Severity of Illness Index
Time Factors
Treatment Outcome
Triglycerides / blood
United States
Weight Loss*
Grant Support
ID/Acronym/Agency:
DK 046204/DK/NIDDK NIH HHS; DK56990/DK/NIDDK NIH HHS; DK56992/DK/NIDDK NIH HHS; DK57002/DK/NIDDK NIH HHS; DK57008/DK/NIDDK NIH HHS; DK57078/DK/NIDDK NIH HHS; DK57131/DK/NIDDK NIH HHS; DK57135/DK/NIDDK NIH HHS; DK57136/DK/NIDDK NIH HHS; DK57149/DK/NIDDK NIH HHS; DK57151/DK/NIDDK NIH HHS; DK57154/DK/NIDDK NIH HHS; DK57171/DK/NIDDK NIH HHS; DK57177/DK/NIDDK NIH HHS; DK57178/DK/NIDDK NIH HHS; DK57182/DK/NIDDK NIH HHS; DK57219/DK/NIDDK NIH HHS; M01RR000056/RR/NCRR NIH HHS; M01RR00051/RR/NCRR NIH HHS; M01RR0021140/RR/NCRR NIH HHS; M01RR01066/RR/NCRR NIH HHS; M01RR01346/RR/NCRR NIH HHS; M01RR02719/RR/NCRR NIH HHS; P30 DK48520/DK/NIDDK NIH HHS; U01 DK056992-07/DK/NIDDK NIH HHS; UL1 RR 024153/RR/NCRR NIH HHS
Chemical
Reg. No./Substance:
0/Biological Markers; 0/Blood Glucose; 0/Cholesterol, HDL; 0/Cholesterol, LDL; 0/Triglycerides
Investigator
Investigator/Affiliation:
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 / ; Frederick L Brancati / ; Lee Swartz / ; Lawrence Cheskin / ; Jeanne M Clark / ; Kerry Stewart / ; Richard Rubin / ; Jean Arceci / ; Suzanne Bau / ; Jeanne Charleston / ; Danielle Diggins / ; Mia Johnson / ; Joyce Lambert / ; Kathy Michalski / ; Daron Niggetts / ; Chanchai Sapun / ; George A Bray / ; Kristi Rau / ; Allison Strate / ; Frank L Greenway / ; Donna H Ryan / ; Donald Williamson / ; Brandi Armand / ; Jennifer Arceneaux / ; Amy Bachand / ; Michelle Begnaud / ; Betsy Berhard / ; Elizabeth Caderette / ; Barbara Cerniauskas / ; David Creel / ; Diane Crow / ; Crystal Duncan / ; Helen Guay / ; Carolyn Johnson / ; Lisa Jones / ; Nancy Kora / ; Kelly LaFleur / ; Kim Landry / ; Missy Lingle / ; Jennifer Perault / ; Cindy Puckett / ; Mandy Shipp / ; Marisa Smith / ; Elizabeth Tucker / ; Cora E Lewis / ; Sheikilya Thomas / ; Monika Safford / ; Vicki DiLillo / ; Charlotte Bragg / ; Amy Dobelstein / ; Stacey Gilbert / ; Stephen Glasser / ; Sara Hannum / ; Anne Hubbell / ; Jennifer Jones / ; DeLavallade Lee / ; Ruth Luketic / ; L Christie Oden / ; Janet Raines / ; Cathy Roche / ; Janet Truman / ; Nita Webb / ; Casey Azuero / ; Jane King / ; Andre Morgan / ; David M Nathan / ; Enrico Cagliero / ; Kathryn Hayward / ; Heather Turgeon / ; Linda Delahanty / ; Ellen Anderson / ; Laurie Bissett / ; Valerie Goldman / ; Virginia Harlan / ; Theresa Michel / ; Mary Larkin / ; Christine Stevens / ; Kylee Miller / ; Jimmy Chen / ; Karen Blumenthal / ; Gail Winning / ; Rita Tsay / ; Helen Cyr / ; Maria Pinto / ; Edward S Horton / ; Sharon D Jackson / ; Osama Hamdy / ; A Enrique Caballero / ; Sarah Bain / ; Elizabeth Bovaird / ; Barbara Fargnoli / ; Jeanne Spellman / ; Ann Goebel-Fabbri / ; Lori Lambert / ; Sarah Ledbury / ; Maureen Malloy / ; Kerry Ovalle / ; George Blackburn / ; Christos Mantzoros / ; Ann McNamara / ; Kristina Spellman / ; James O Hill / ; Marsha Miller / ; Brent Van Dorsten / ; Judith Regensteiner / ; Ligia Coelho / ; Paulette Cohrs / ; Susan Green / ; April Hamilton / ; Jere Hamilton / ; Eugene Leshchinskiy / ; Lindsey Munkwitz / ; Loretta Rome / ; Terra Worley / ; Kirstie Craul / ; Sheila Smith / ; John P Foreyt / ; Rebecca S Reeves / ; Henry Pownall / ; Ashok Balasubramanyam / ; Peter Jones / ; Michele Burrington / ; Chu-Huang Chen / ; Allyson Clark Gardner / ; Molly Gee / ; Sharon Griggs / ; Michelle Hamilton / ; Veronica Holley / ; Jayne Joseph / ; Julieta Palencia / ; Jennifer Schmidt / ; Carolyn White / ; Karen C Johnson / ; Carolyn Gresham / ; Stephanie Connelly / ; Amy Brewer / ; Mace Coday / ; Lisa Jones / ; Lynne Lichtermann / ; Shirley Vosburg / ; J Lee Taylor / ; Abbas E Kitabchi / ; Ebenezer Nyenwe / ; Helen Lambeth / ; Amy Brewer / ; Debra Clark / ; Andrea Crisler / ; Debra Force / ; Donna Green / ; Robert Kores / ; Robert W Jeffery / ; Carolyn Thorson / ; John P Bantle / ; J Bruce Redmon / ; Richard S Crow / ; Scott Crow / ; Susan K Raatz / ; Kerrin Brelje / ; Carolyne Campbell / ; Jeanne Carls / ; Tara Carmean-Mihm / ; Julia Devonish / ; Emily Finch / ; Anna Fox / ; Elizabeth Hoelscher / ; La Donna James / ; Vicki A Maddy / ; Therese Ockenden / ; Birgitta I Rice / ; Tricia Skarphol / ; Ann D Tucker / ; Mary Susan Voeller / ; Cara Walcheck / ; Xavier Pi-Sunyer / ; Jennifer Patricio / ; Stanley Heshka / ; Carmen Pal / ; Lynn Allen / ; Lolline Chong / ; Marci Gluck / ; Diane Hirsch / ; Mary Anne Holowaty / ; Michelle Horowitz / ; Nancy Rau / ; Dori Brill Steinberg / ; Thomas A Wadden / ; Barbara J Maschak-Carey / ; Robert I Berkowitz / ; Seth Braunstein / ; Gary Foster / ; Henry Glick / ; Shiriki Kumanyika / ; Stanley S Schwartz / ; Michael Allen / ; Johanna Brock / ; Susan Brozena / ; Ray Carvajal / ; Helen Chomentowski / ; Canice Crerand / ; Renee Davenport / ; Andrea Diamond / ; Anthony Fabricatore / ; Lee Goldberg / ; Louise Hesson / ; Thomas Hudak / ; Nayyar Iqbal / ; LaShanda Jones-Corneille / ; Andrew Kao / ; Robert Kuehnel / ; Patricia Lipschutz / ; Monica Mullen / ; John M Jakicic / ; David E Kelley / ; Jacqueline Wesche-Thobaben / ; Lewis H Kuller / ; Andrea Kriska / ; Amy D Otto / ; Lin Ewing / ; Mary Korytkowski / ; Daniel Edmundowicz / ; Monica E Yamamoto / ; Rebecca Danchenko / ; Barbara Elnyczky / ; David O Garcia / ; George A Grove / ; Patricia H Harper / ; Susan Harrier / ; Nicole L Helbling / ; Diane Ives / ; Juliet Mancino / ; Anne Mathews / ; Tracey Y Murray / ; Joan R Ritchea / ; Susan Urda / ; Donna L Wolf / ; Rena R Wing / ; Renee Bright / ; Vincent Pera / ; John Jakicic / ; Deborah Tate / ; Amy Gorin / ; Kara Gallagher / ; Amy Bach / ; Barbara Bancroft / ; Anna Bertorelli / ; Richard Carey / ; Tatum Charron / ; Heather Chenot / ; Kimberley Chula-Maguire / ; Pamela Coward / ; Lisa Cronkite / ; Julie Currin / ; Maureen Daly / ; Caitlin Egan / ; Erica Ferguson / ; Linda Foss / ; Jennifer Gauvin / ; Don Kieffer / ; Lauren Lessard / ; Deborah Maier / ; J P Massaro / ; Tammy Monk / ; Rob Nicholson / ; Erin Patterson / ; Suzanne Phelan / ; Hollie Raynor / ; Douglas Raynor / ; Natalie Robinson / ; Deborah Robles / ; Jane Tavares / ; Steven M Haffner / ; Maria G Montez / ; Carlos Lorenzo / ; Charles F Coleman / ; Domingo Granado / ; Kathy Hathaway / ; Juan Carlos Isaac / ; Nora Ramirez / ; Ronda Saenz / ; Steven Kahn / ; Brenda Montgomery / ; Robert Knopp / ; Edward Lipkin / ; Dace Trence / ; Terry Barrett / ; Joli Bartell / ; Diane Greenberg / ; Anne Murillo / ; Betty Ann Richmond / ; Jolanta Socha / ; April Thomas / ; Alan Wesley / ; William C Knowler / ; Paula Bolin / ; Tina Killean / ; Cathy Manus / ; Jonathan Krakoff / ; Jeffrey M Curtis / ; Justin Glass / ; Sara Michaels / ; Peter H Bennett / ; Tina Morgan / ; Shandiin Begay / ; Paul Bloomquist / ; Teddy Costa / ; Bernadita Fallis / ; Jeanette Hermes / ; Diane F Hollowbreast / ; Ruby Johnson / ; Maria Meacham / ; Julie Nelson / ; Carol Percy / ; Patricia Poorthunder / ; Sandra Sangster / ; Nancy Scurlock / ; Leigh A Shovestull / ; Janelia Smiley / ; Katie Toledo / ; Christina Tomchee / ; Darryl Tonemah / ; Anne Peters / ; Valerie Ruelas / ; Siran Ghazarian Sengardi / ; Kathryn Mandy Graves Hillstrom / ; Kati Konersman / ; Sara Serafin-Dokhan / ; Mark A Espeland / ; Judy L Bahnson / ; Lynne E Wagenknecht / ; David Reboussin / ; W Jack Rejeski / ; Alain G Bertoni / ; Wei Lang / ; Michael S Lawlor / ; David Lefkowitz / ; Gary D Miller / ; Patrick S Reynolds / ; Paul M Ribisl / ; Mara Vitolins / ; Haiying Chen / ; Delia S West / ; Lawrence M Friedman / ; Brenda L Craven / ; Kathy M Dotson / ; Amelia Hodges / ; Carrie C Williams / ; Andrea Anderson / ; Jerry M Barnes / ; Mary Barr / ; Daniel P Beavers / ; Tara Beckner / ; Thania Del Valle-Fagan / ; Patricia A Feeney / ; Candace Goode / ; Jason Griffin / ; Lea Harvin / ; Patricia Hogan / ; Sarah A Gaussoin / ; Mark King / ; Kathy Lane / ; Rebecca H Neiberg / ; Michael P Walkup / ; Karen Wall / ; Terri Windham / ; Michael Nevitt / ; Ann Schwartz / ; John Shepherd / ; Michaela Rahorst / ; Lisa Palermo / ; Susan Ewing / ; Cynthia Hayashi / ; Jason Maeda / ; Santica M Marcovina / ; Jessica Chmielewski / ; Vinod Gaur / ; Elsayed Z Soliman / ; Ronald J Prineas / ; Charles Campbell / ; Zhu-Ming Zhang / ; Teresa Alexander / ; Lisa Keasler / ; Susan Hensley / ; Yabing Li / ; Robert Moran / ; Richard Foushee / ; Nancy J Hall / ; Mary Evans / ; Barbara Harrison / ; Van S Hubbard / ; Susan Z Yanovski / ; Robert Kuczmarski / ; Lawton S Cooper / ; Peter Kaufman / ; Edward W Gregg / ; David F Williamson / ; Ping Zhang /
Comments/Corrections
Comment In:
Arch Intern Med. 2010 Sep 27;170(17):1575-7   [PMID:  20876409 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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