Four years on, intensive lifestyle changes yield benefits over standard diabetes care

June 26, 2011

Four years into a 13-plus-year study, an intensive lifestyle intervention (ILI) for patients with type 2 diabetes mellitus has produced sustained, significant improvements in glycemic control, systolic blood pressure, and high-density lipoprotein (HDL) cholesterol compared with standard diabetes support and education (DSE) programs, reported investigators with the Look AHEAD (Action for Health in Diabetes) trial.

Four years into a 13-plus-year study, an intensive lifestyle intervention (ILI) for patients with type 2 diabetes mellitus has produced sustained, significant improvements in glycemic control, systolic blood pressure, and high-density lipoprotein (HDL) cholesterol compared with standard diabetes support and education (DSE) programs, reported investigators with the Look AHEAD (Action for Health in Diabetes) trial.
      “Intensive lifestyle intervention has been effective in promoting and maintaining weight loss and improving fitness through 4 years of follow-up,” reported F. Xavier Pi-Sunyer, MD, Professor and Chief of Endocrinology, Diabetes and Nutrition at Columbia University College of Physicians and Surgeons in New York City.
      The ILI was associated with greater decreases in glycosylated hemoglobin (HbA1c) and lower use of diabetes medications, including insulin. Additionally, a greater percentage of patients in the intervention arm of the ongoing trial have been able to achieve American Diabetes Association HbA1c goals.
      The Look AHEAD study is an ongoing multicenter, randomized clinical trial of 5145 overweight or obese adults with type 2 diabetes. The mean patient age at baseline was 58.7 years, and 59.5% were women. Pi-Sunyer presented 4-year follow-up results from the trial, for which up to 13.5 years of follow-up are planned. Participants were randomly assigned into either the ILI or DSE arm.
      In the ILI arm, participants are advised to get no more than 30% of their daily calories from fat and receive meal replacements and menu plans. They also are instructed to gradually achieve 175 minutes or more per week of physical activity, walk at least 10,000 steps per day, and receive both individual and group support sessions in the first year.
      Participants in the DSE arm attend 3 to 4 meetings per year to discuss health topics, including diet, exercise, and social support.
      On average over 4 years, participants in the ILI group lost a greater percentage of their body weight compared with those in the DSE group (-6.15% vs. -0.88%; P < .001). Those in the ILI group also had larger improvements in fitness on a treadmill test (12.74% vs. 1.96%; P < .001), as well as significant improvements in glycemic parameters (HbA1c level -0.36% vs. -0.09%; P < .001) compared with members of the DSE group.
      Members of the intervention group also had better improvement in systolic and diastolic blood pressure and in levels of both HDL cholesterol and triglycerides.
      Participants in the DSE group had significantly better reductions in low-density lipoprotein cholesterol, but this was due to higher use of lipid-lowering drugs in the control group.
      The investigators are continuing to follow Look AHEAD participants to determine whether ILI can significantly reduce cardiovascular risk factors, morbidity, and mortality.