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Defeat Diabetes
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Lifestyle Change Cuts Weight, CVD Risk in Diabetes

Posted: Thursday, November 16, 2006

Control group had lost a mean of 8.3% of their body weight.

One-year data obtained from a large, federally funded trial have shown that intensive lifestyle intervention can produce significant weight loss and reduce cardiovascular risk factors in patients with type 2 diabetes.

Look AHEAD (Action for Health in Diabetes) is an ongoing, 16-center randomized clinical trial designed to determine whether intensive lifestyle modification can reduce the rates of both MI and stroke in overweight volunteers with type 2 diabetes over a planned follow-up of 11.5 years, compared with traditional medical care.

The study includes 5,145 patients with type 2 diabetes with a mean age of 59 years and mean BMI of 36 kg/m2; 37% are from ethnic/racial minority groups. About 15% are insulin users, and the same proportion have a history of a prior CVD event. They receive care from their own physicians in the community, while the study sites provide the intervention.

The intensive lifestyle intervention (ILI), to which 2,570 patients were randomized, consisted of an initial 6-month phase in which they attended three group sessions and one individual session per month, all conducted by trained diabetes educators and emphasizing nutrition and physical activity aiming at a personal weight-loss goal of 10% from baseline.

During months 7–12, subjects attended two or three sessions per month, either individually or in a group. Those who had achieved the first goal were aiming to maintain their weights, while those who hadn't continued to aim for the 10% loss.

Calorie recommendations were calculated based on baseline and goal weights, and set at 1,200–1,500 kcal/day for those weighing up to 250 pounds at baseline and 1,500–1,800 kcal/day for those weighing more than 250 pounds. Exercise was gradually increased to at least 25 minutes/day. Most subjects walked, aiming for 10,000 steps/day, said Dr. Pi-Sunyer, director of the Obesity Research Center, St. Luke's-Roosevelt Hospital Center, New York.

The 2,575 control patients received diabetes support and education (DSE) consisting of three to four group meetings per year in which diet, exercise, and social support were discussed but no intervention was actually delivered, he said.

Of the 97% of subjects who attended the 1-year exam, the ILI group had lost a mean of 8.3% of their body weight, compared with 0.4% in the control group, a highly significant difference. The average weight loss was 18 pounds. Fitness, as measured by treadmill testing, improved by 16% in the ILI group and 11% in the controls, after adjustment for weight loss. Fitness improved significantly across all body mass indexes and in both genders and all the ethnic/minority groups. Changes in fitness were highly correlated with changes in activity level and in body weight, Dr. Pi-Sunyer said.

Systolic blood pressure dropped by 6.8 mm Hg in the ILI group vs. 2.8 mm Hg with DSE, and diastolic by 3.0 mm Hg vs. 1.8 mm Hg. Again, the reduction was significant only for ILI. While LDL-cholesterol levels didn't change significantly in either group, HDL cholesterol rose to a greater degree with ILI (3.4 vs. 1.4 mg/dL). Triglycerides dropped by 30.3 mg/dL with ILI, vs. 14.6 mg/dL for DSE.

Hemoglobin A1c levels dropped from 7.25% at baseline to 6.6% at 1 year in the ILI group, a highly significant difference. In contrast, the drop from 7.3% to 7.15% in the DSE group was not significant. Similarly, fasting glucose dropped by a mean of 21.5 mg/dL with ILI, compared with just 7.2 mg/dL in the DSE group. The improved hemoglobin A1c occurred despite a greater reduction in glucose-lowering medications in the ILI group, Dr. Pi-Sunyer noted.

At 1 year, the ILI group was taking an average of 2.7 medications for glucose, blood pressure, and/or lipid lowering, compared with 3.2 for the DSE group.



Source: Diabetes In Control: Internal Medicine Volume 39, Issue 21, Page 27

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