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BMJ Open Diabetes Res Care. 2017 Jan 4;5(1):e000259. doi: 10.1136/bmjdrc-2016-000259. eCollection 2017.

Long-term effect of intensive lifestyle intervention on cardiovascular risk factors in patients with diabetes in real-world clinical practice: a 5-year longitudinal study.

Author information

1
Joslin Diabetes Center, Harvard Medical School , Boston, Massachusetts , USA.

Abstract

OBJECTIVE:

We evaluated long-term impact of sustained weight loss versus weight regain on cardiovascular risk factors in real-world clinical practice.

METHODS:

We evaluated 129 obese patients with diabetes enrolled in Weight Achievement and Intensive Treatment (Why WAIT) program, a 12-week clinical model of intensive lifestyle intervention. After 1 year, we divided participants into group A, who maintained <7% weight loss (47.3%) and group B (52.7%), who maintained ≥7% weight loss. We continued to follow them for a total of 5 years.

RESULTS:

The total cohort lost 23.8 lbs (-9.7%) at 12 weeks and maintained -16.2 lbs (-6.4%) at 5 years (p<0.001). Group A maintained -8.4 lbs (-3.5%) and group B maintained -23.1 lbs (-9.0%) at 5 years. In group A, A1C decreased from 7.5±1.3% to 6.7±0.9% at 12 weeks but increased to 7.7±1.4% at 1 year and 8.0±1.9% at 5 years. In group B, A1C decreased from 7.4±1.2% to 6.4±0.9% at 12 weeks and rose to 6.8±1.2% at 1 year and 7.3±1.5% at 5 years. Despite weight regain, group A maintained improvement in low-density lipoprotein-cholesterol and high-density lipoprotein-cholesterol with worsening of serum triglycerides and no change in blood pressure (BP). Group B maintained improvement in lipid profile for 5 years and had significantly lower BP for 18 months.

CONCLUSIONS:

Weight reduction in patients with diabetes can be maintained for 5 years and is predicted by patients' ability to maintain ≥7% weight loss at 1 year. A1C and triglycerides deteriorate with weight regain, while other lipid improvements are maintained. Sustained weight loss is associated with significantly lower A1C for 5 years and lowers BP for 18 months.

TRIAL REGISTRATION NUMBER:

NCT01937845.

KEYWORDS:

Cardiovascular Disease Risk; Lifestyle Intervention(s); Weight Management

Conflict of interest statement

OH receives research support from Neurometrix and Metagenics and consults to Merck Pharmaceutical and Abbott Nutrition. None of the authors’ financial interests are related or influenced this study. Other authors do not have any competing interests to disclose.

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