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Diabetes Care. 2018 May;41(5):1040-1048. doi: 10.2337/dc17-2110. Epub 2018 Mar 15.

Impact of Intensive Lifestyle Intervention on Disability-Free Life Expectancy: The Look AHEAD Study.

Author information

1
Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA edg7@cdc.gov.
2
Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA.
3
Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC.
4
Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC.
5
Merck & Co., North Wales, PA.
6
Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA.
7
Sticht Center on Aging, Wake Forest School of Medicine, Winston-Salem, NC.
8
Keck School of Medicine, University of Southern California, Los Angeles, CA.
9
Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC.

Abstract

OBJECTIVE:

The impact of weight loss intervention on disability-free life expectancy in adults with diabetes is unknown. We examined the impact of a long-term weight loss intervention on years spent with and without physical disability.

RESEARCH DESIGN AND METHODS:

Overweight or obese adults with type 2 diabetes age 45-76 years (n = 5,145) were randomly assigned to a 10-year intensive lifestyle intervention (ILI) or diabetes support and education (DSE). Physical function was assessed annually for 12 years using the 36-Item Short Form Health Survey. Annual incidence of physical disability, mortality, and disability remission were incorporated into a Markov model to quantify years of life spent active and physically disabled.

RESULTS:

Physical disability incidence was lower in the ILI group (6.0% per year) than in the DSE group (6.8% per year) (incidence rate ratio 0.88 [95% CI 0.81-0.96]), whereas rates of disability remission and mortality did not differ between groups. ILI participants had a significant delay in moderate or severe disability onset and an increase in number of nondisabled years (P < 0.05) compared with DSE participants. For a 60-year-old, this effect translates to 0.9 more disability-free years (12.0 years [95% CI 11.5-12.4] vs. 11.1 years [95% CI 10.6-11.7]) but no difference in total years of life. In stratified analyses, ILI increased disability-free years of life in women and participants without cardiovascular disease (CVD) but not in men or participants with CVD.

CONCLUSIONS:

Long-term lifestyle interventions among overweight or obese adults with type 2 diabetes may reduce long-term disability, leading to an effect on disability-free life expectancy but not on total life expectancy.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT00017953.

PMID:
29545462
PMCID:
PMC5911793
DOI:
10.2337/dc17-2110
[Indexed for MEDLINE]
Free PMC Article

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