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Arch Intern Med. 2010 Sep 27;170(17):1566-75. 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.

Collaborators (435)

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, Brancati FL, Swartz L, Cheskin L, Clark JM, Stewart K, Rubin R, Arceci J, Bau S, Charleston J, Diggins D, Johnson M, Lambert J, Michalski K, Niggetts D, Sapun C, Bray GA, Rau K, Strate A, Greenway FL, Ryan DH, Williamson D, Armand B, Arceneaux J, Bachand A, Begnaud M, Berhard B, Caderette E, Cerniauskas B, Creel D, Crow D, Duncan C, Guay H, Johnson C, Jones L, Kora N, LaFleur K, Landry K, Lingle M, Perault J, Puckett C, Shipp M, Smith M, Tucker E, Lewis CE, Thomas S, Safford M, DiLillo V, Bragg C, Dobelstein A, Gilbert S, Glasser S, Hannum S, Hubbell A, Jones J, Lee D, Luketic R, Oden LC, Raines J, Roche C, Truman J, Webb N, Azuero C, King J, Morgan A, Nathan DM, Cagliero E, Hayward K, Turgeon H, Delahanty L, Anderson E, Bissett L, Goldman V, Harlan V, Michel T, Larkin M, Stevens C, Miller K, Chen J, Blumenthal K, Winning G, Tsay R, Cyr H, Pinto M, Horton ES, Jackson SD, Hamdy O, Caballero AE, Bain S, Bovaird E, Fargnoli B, Spellman J, Goebel-Fabbri A, Lambert L, Ledbury S, Malloy M, Ovalle K, Blackburn G, Mantzoros C, McNamara A, Spellman K, Hill JO, Miller M, Van Dorsten B, Regensteiner J, Coelho L, Cohrs P, Green S, Hamilton A, Hamilton J, Leshchinskiy E, Munkwitz L, Rome L, Worley T, Craul K, Smith S, Foreyt JP, Reeves RS, Pownall H, Balasubramanyam A, Jones P, Burrington M, Chen CH, Gardner AC, Gee M, Griggs S, Hamilton M, Holley V, Joseph J, Palencia J, Schmidt J, White C, Johnson KC, Gresham C, Connelly S, Brewer A, Coday M, Jones L, Lichtermann L, Vosburg S, Taylor JL, Kitabchi AE, Nyenwe E, Lambeth H, Brewer A, Clark D, Crisler A, Force D, Green D, Kores R, Jeffery RW, Thorson C, Bantle JP, Redmon JB, Crow RS, Crow S, Raatz SK, Brelje K, Campbell C, Carls J, Carmean-Mihm T, Devonish J, Finch E, Fox A, Hoelscher E, James LD, Maddy VA, Ockenden T, Rice BI, Skarphol T, Tucker AD, Voeller MS, Walcheck C, Pi-Sunyer X, Patricio J, Heshka S, Pal C, Allen L, Chong L, Gluck M, Hirsch D, Holowaty MA, Horowitz M, Rau N, Steinberg DB, Wadden TA, Maschak-Carey BJ, Berkowitz RI, Braunstein S, Foster G, Glick H, Kumanyika S, Schwartz SS, Allen M, Brock J, Brozena S, Carvajal R, Chomentowski H, Crerand C, Davenport R, Diamond A, Fabricatore A, Goldberg L, Hesson L, Hudak T, Iqbal N, Jones-Corneille L, Kao A, Kuehnel R, Lipschutz P, Mullen M, Jakicic JM, Kelley DE, Wesche-Thobaben J, Kuller LH, Kriska A, Otto AD, Ewing L, Korytkowski M, Edmundowicz D, Yamamoto ME, Danchenko R, Elnyczky B, Garcia DO, Grove GA, Harper PH, Harrier S, Helbling NL, Ives D, Mancino J, Mathews A, Murray TY, Ritchea JR, Urda S, Wolf DL, Wing RR, Bright R, Pera V, Jakicic J, Tate D, Gorin A, Gallagher K, Bach A, Bancroft B, Bertorelli A, Carey R, Charron T, Chenot H, Chula-Maguire K, Coward P, Cronkite L, Currin J, Daly M, Egan C, Ferguson E, Foss L, Gauvin J, Kieffer D, Lessard L, Maier D, Massaro JP, Monk T, Nicholson R, Patterson E, Phelan S, Raynor H, Raynor D, Robinson N, Robles D, Tavares J, Haffner SM, Montez MG, Lorenzo C, Coleman CF, Granado D, Hathaway K, Isaac JC, Ramirez N, Saenz R, Kahn S, Montgomery B, Knopp R, Lipkin E, Trence D, Barrett T, Bartell J, Greenberg D, Murillo A, Richmond BA, Socha J, Thomas A, Wesley A, Knowler WC, Bolin P, Killean T, Manus C, Krakoff J, Curtis JM, Glass J, Michaels S, Bennett PH, Morgan T, Begay S, Bloomquist P, Costa T, Fallis B, Hermes J, Hollowbreast DF, Johnson R, Meacham M, Nelson J, Percy C, Poorthunder P, Sangster S, Scurlock N, Shovestull LA, Smiley J, Toledo K, Tomchee C, Tonemah D, Peters A, Ruelas V, Sengardi SG, Hillstrom KM, Konersman K, Serafin-Dokhan S, Espeland MA, Bahnson JL, Wagenknecht LE, Reboussin D, Rejeski WJ, Bertoni AG, Lang W, Lawlor MS, Lefkowitz D, Miller GD, Reynolds PS, Ribisl PM, Vitolins M, Chen H, West DS, Friedman LM, Craven BL, Dotson KM, Hodges A, Williams CC, Anderson A, Barnes JM, Barr M, Beavers DP, Beckner T, Del Valle-Fagan T, Feeney PA, Goode C, Griffin J, Harvin L, Hogan P, Gaussoin SA, King M, Lane K, Neiberg RH, Walkup MP, Wall K, Windham T, Nevitt M, Schwartz A, Shepherd J, Rahorst M, Palermo L, Ewing S, Hayashi C, Maeda J, Marcovina SM, Chmielewski J, Gaur V, Soliman EZ, Prineas RJ, Campbell C, Zhang ZM, Alexander T, Keasler L, Hensley S, Li Y, Moran R, Foushee R, Hall NJ, Evans M, Harrison B, Hubbard VS, Yanovski SZ, Kuczmarski R, Cooper LS, Kaufman P, Gregg EW, Williamson DF, Zhang P.

Author information

  • 1Department of Psychiatry, The Miriam Hospital/Brown Medical School, Providence, RI 02860, USA. rwing@lifespan.org

Abstract

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.

Comment in

PMID:
20876408
[PubMed - indexed for MEDLINE]
PMCID:
PMC3084497
Free PMC Article

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