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N Engl J Med. 2012 Mar 29;366(13):1209-17. doi: 10.1056/NEJMoa1110294.

Lifestyle change and mobility in obese adults with type 2 diabetes.

Collaborators (397)

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 A, 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, Chen CH, Burrington M, 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 J, 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 J, 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, Bell Y, 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 W, 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, Davis C, 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

  • 1Reynolda Campus, Wake Forest University, Winston-Salem, NC 27109, USA. rejeski@wfu.edu

Abstract

BACKGROUND:

Adults with type 2 diabetes mellitus often have limitations in mobility that increase with age. An intensive lifestyle intervention that produces weight loss and improves fitness could slow the loss of mobility in such patients.

METHODS:

We randomly assigned 5145 overweight or obese adults between the ages of 45 and 74 years with type 2 diabetes to either an intensive lifestyle intervention or a diabetes support-and-education program; 5016 participants contributed data. We used hidden Markov models to characterize disability states and mixed-effects ordinal logistic regression to estimate the probability of functional decline. The primary outcome was self-reported limitation in mobility, with annual assessments for 4 years.

RESULTS:

At year 4, among 2514 adults in the lifestyle-intervention group, 517 (20.6%) had severe disability and 969 (38.5%) had good mobility; the numbers among 2502 participants in the support group were 656 (26.2%) and 798 (31.9%), respectively. The lifestyle-intervention group had a relative reduction of 48% in the risk of loss of mobility, as compared with the support group (odds ratio, 0.52; 95% confidence interval, 0.44 to 0.63; P<0.001). Both weight loss and improved fitness (as assessed on treadmill testing) were significant mediators of this effect (P<0.001 for both variables). Adverse events that were related to the lifestyle intervention included a slightly higher frequency of musculoskeletal symptoms at year 1.

CONCLUSIONS:

Weight loss and improved fitness slowed the decline in mobility in overweight adults with type 2 diabetes. (Funded by the Department of Health and Human Services and others; ClinicalTrials.gov number, NCT00017953.).

Comment in

PMID:
22455415
[PubMed - indexed for MEDLINE]
PMCID:
PMC3339039
Free PMC Article

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