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Thursday, November 8, 2012

New diabetes data puzzles

From: Editor, 

Diabetes is often associated with obesity and obesity with cardiovascular disease. However, an intensive diet and exercise program resulting in weight loss does not reduce cardiovascular events such as heart attack and stroke in people with longstanding type 2 diabetes, according to a study supported by the National Institutes of Health.

Look AHEAD (Action For Health in Diabetes) is a multicenter randomized clinical trial to examine the effects of a lifestyle intervention designed to achieve and maintain weight loss over the long term through decreased caloric intake and exercise. Look AHEAD is focusing on the disease most affected by overweight and obesity, type 2 diabetes, and on the outcome that causes the greatest morbidity and mortality, cardiovascular disease.

The Look AHEAD trial looked at the benefits of weight loss and exercise in the treatment of type 2 diabetes. Patients lost weight, increased their physical activity, and did it over a long period of time -- for up to 11 years.  The primary outcome of this study was a macrovascular event outcome. It consisted of nonfatal myocardial infarction, nonfatal stroke, death, or hospitalization for angina. In terms of the primary outcome, we did not see a difference between the 2 groups at 11 years.

A number of lifestyle factors are known to be important to the development of type 2 diabetes, including: obesity (defined by a body mass index of greater than thirty), lack of physical activity, poor diet, stress, and urbanization.

"Look AHEAD found that people who are obese and have type 2 diabetes can lose weight and maintain their weight loss with a lifestyle intervention," said Dr. Rena Wing, chair of the Look AHEAD study and professor of psychiatry and human behavior at Brown University. "Although the study found weight loss had many positive health benefits for people with type 2 diabetes, the weight loss did not reduce the number of cardiovascular events."

Few, if any, studies of this size and duration have had comparable success in achieving and maintaining weight loss. Participants in the intervention group lost an average of more than 8 percent of their initial body weight after one year of intervention. They maintained an average weight loss of nearly 5 percent at four years, an amount of weight loss that experts recommend to improve health. Participants in the diabetes support and education group lost about 1 percent of their initial weight after one and four years.

This study consisted of 5145 adults with type 2 diabetes who had a body mass index (BMI) > 25. They were overweight when they came in to the study and were randomly assigned to the intensive lifestyle arm or the diabetes support and education (DSE) arm, which was, in essence, the control group who were given education and meetings twice a year, but they were not given the intervention that were provided to the lifestyle group.

The intensive lifestyle group were given individual sessions with a nutritionist and/or a trainer, they had group sessions, they had refresher courses, and they were given all the tools they needed to really work on and succeed at their lifestyle intervention.  However, what was not shown was a reduction in cardiovascular events and death.

Weight loss and exercise can prevent diabetes.   Lifestyle changes can help prevent diabetes. But that seems all there is once you have diabetes.

For further information see Look Ahead