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Original Investigation
September 27, 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

Author Affiliations

Author Affiliations: Rena R. Wing, PhD, and Caitlin Egan, MS, The Miriam Hospital and Brown Medical School, Providence, Rhode Island; Judy L. Bahnson, BA, CCRP, Mark A. Espeland, PhD, David Reboussin, PhD, W. Jack Rejeski, PhD, and Lynne Wagenknecht, DrPH, Wake Forest University School of Medicine, Winston-Salem, North Carolina; George A. Bray, MD, Pennington Biomedical Research Center, Baton Rouge, Louisiana; Jeanne M. Clark, MD, MPH, and Richard Rubin, PhD, The Johns Hopkins University, Baltimore, Maryland; Mace Coday, PhD, Memphis East Clinic, Memphis, Tennessee; John P. Foreyt, PhD, and Henry Pownall, PhD, Baylor College of Medicine, Houston, Texas; Edward W. Gregg, PhD, and Donald Williamson, PhD, Centers for Disease Control and Prevention, Atlanta, Georgia; Valerie Goldman, MS, RD, and David M. Nathan, MD, Massachusetts General Hospital, Boston; Steven M. Haffner, MD, Helen Hazuda, PhD, and Maria Montez, RN, MSHP, CDE, The University of Texas Health Science Center at San Antonio; James O. Hill, PhD, University of Colorado Health Sciences Center, Denver; Edward S. Horton, MD, Joslin Diabetes Center, Boston; Van S. Hubbard, MD, PhD, and Susan Z. Yanovski, MD, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland; John Jakicic, PhD, and Jacqueline Wesche-Thobaben, RN, BSN, CDE, University of Pittsburgh, Pittsburgh, Pennsylvania; Robert W. Jeffery, PhD, and Tricia Skarphol, MA, University of Minnesota, Minneapolis; Karen C. Johnson, MD, MPH, and Abbas E. Kitabchi, PhD, MD, The University of Tennessee Health Science Center, Memphis; Steven Kahn, MB ChB, and Brenda Montgomery, RN, MS, CDE, Veterans Affairs (VA) Puget Sound Health Care System and University of Washington, Seattle; Tina Killean, BS, Cathy Manus, LPN, and Sara Michaels, MD, Northern Navajo Medical Center, Shiprock, New Mexico; Cora E. Lewis, MD, MSPH, and Monika Safford, MD, The University of Alabama at Birmingham; Barbara J. Maschak-Carey, MSN, CDE, and Thomas A. Wadden, PhD, University of Pennsylvania, Philadelphia; Jennifer Patricio, MS, and Xavier Pi-Sunyer, MD, St. Luke’s–Roosevelt Hospital, New York, New York; Anne Peters, MD, University of Southern California, Los Angeles; Brent Van Dorsten, PhD, University of Colorado Denver School of Medicine, Aurora; and Delia S. West, PhD, University of Arkansas for Medical Sciences, Little Rock.

Arch Intern Med. 2010;170(17):1566-1575. doi:10.1001/archinternmed.2010.334

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 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 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