Reduction in Weight and Cardiovascular Disease Risk Factors in Individuals With Type 2 Diabetes: One-year results of the Look AHEAD trial.
The Look AHEAD Research Group. Diabetes Care. 2007;30(6):1374-1383.
Objective
To report the 1-year changes in cardiovascular risk factors in a trial designed to examine the long-term effects of an intensive lifestyle intervention (ILI) that includes diet, physical activity and behavior modification on the incidence of cardiovascular events in people with type 2 diabetes.
Methods
This multicentered, randomized, controlled clinical trial enrolled 5,145 overweight people (BMI >25 kg/mm2 />27 kg/mm2 if taking insulin) with type 2 diabetes, ages 45-74 years. Individuals were randomized to one of two groups: 1) an intensive lifestyle intervention (ILI) group which included a weight loss intervention of a calorie-controlled diet that included the use of 2 liquid meal replacements daily for the first 6 months and 1 daily for the next 6 months, along with frozen food entrees, in addition to behavior modification and increased physical activity designed to induce a minimum weight loss of 7% of initial body weight for the first year, or 2) a diabetes support and education (DSE) group.
Results
The 1-year examination was attended by 2,496 of the ILI participants and 2,463 of the DSE participants. The ILI group lost an average of 8.6 +/- 6.9% of initial body weight over the first year--exceeding the study weight loss goal of 7%--as compared with 0.7%+/- 4.8% in the DSE group (p<0.001); achieved an average increase in fitness of 20.9 +/- 29.1% as compared with 5.8 +/- 22.0% among DSE participants (p<0.001); had a reduction in glucose-lowering medications from 86.5 to 78.6% as compared with an increase among DSE participants of 86.5 to 88.7% (p<0.001); and demonstrated a reduction in HbA1c from 7.25 +/- 0.02 to 6.1 +/- 0.02 as compared with 7.29 +/- 0.02 to 7.15 +/- 0.02 for the DSE participants. Blood pressure, HDL cholesterol and triglycerides were significantly improved in the ILI group (p<0.01).
Conclusion
People with type 2 diabetes can achieve a clinically significant weight loss, which is associated with improved cardiovascular risk factors. Meal replacements play a significant role as part of a weight management regimen in helping people with type 2 diabetes achieve clinically significant weight loss, which resulted in better overall fitness, a reduction in the number of diabetes and blood pressure medications, and improved CVD risk factors and glycemic control.
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