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Lifestyle interventions improved risk factors for CVD in type 2 diabetes
Wing RR. Arch Intern Med. 2010;170:1566-1575.
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An intensive lifestyle intervention resulted in weight loss and improvements in glycemic control and cardiovascular risk factors for those with type 2 diabetes, according to results of a 4-year report of the Look AHEAD trial.
In the short term, lifestyle interventions result in improvements to glycemic control and risk factors for CV disease. However, there are no data that establish the long-term effects of lifestyle interventions. The goal of the Look AHEAD (Action for Health in Diabetes) trial was to determine the long-term effects of the interventions and to determine whether these improvements lead to a reduction in CV disease.
The trial included 5,145 overweight or obese people with type 2 diabetes who were recruited from 16 centers in the United States. Within each center, the participants were randomly assigned to an intensive lifestyle intervention or diabetes support and education.
Participants in the intensive lifestyle intervention group took part in diet modification and physical activity. The diabetes support and education group was considered the control group.
Within the 4 years, participants in the intensive lifestyle intervention group experienced improvements in weight, physical activity, glycemic control, blood pressure and HDL levels, compared with the diabetes support and education group. Changes in LDL were the same in both groups.
More people in the intensive lifestyle intervention group were able to discontinue medications to control blood glucose levels or BP, compared with the diabetes support and education group. The percentage of participants using lipid-lowering medication doubled during the 4 years, with more people in the diabetes support and education group initiating the treatment.
“Although medications typically affect only one risk factor, the lifestyle intervention produced positive changes in glycemic control, blood pressure and lipid levels simultaneously,” the researchers wrote. “The critical question is whether the differences between groups in risk factors will translate into differences in the development of CVD.”
We have known for a long time that when you lose weight, you lower insulin resistance, lower triglycerides and improve HDL, and you reduce the presence of CV risk factors. Exercise does exactly the same thing. This is reiterating what we already know. This study does not really provide any new information, but it does show that lowering the risk factors can be sustained over a longer period of time. It would be hard to replicate this in practice, since compliance to the lifestyle is often an issue, especially the weekly doctor appointments. It is a very strict regimen.
– David S.H. Bell, MB, FACE
Endocrine Today Editorial Board member
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