Look AHEAD Study Shows Lifestyle Change Improves Risk Factors in People with Type 2 Diabetes
An intensive lifestyle intervention program improves diabetes control and cardiovascular disease (CVD) risk factors in overweight and obese people with type 2 diabetes, according to results of the Look AHEAD (Action for Health in Diabetes) study. Four-year results of the study were published in the September 27, 2010, issue of the Archives of Internal Medicine.
The Look AHEAD study is a multicenter, randomized clinical trial that ultimately will evaluate the effect of reduced caloric intake and increased physical activity on the incidence of major cardiovascular events such as heart attack, stroke, and CVD-related death. The study’s primary sponsor is the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health.
More than 5,000 participants at 16 study centers across the United States were randomly assigned to one of two interventions—an intensive lifestyle intervention or a diabetes support and education program. The intensive lifestyle intervention was designed to help participants lose about 7 percent of their body weight and maintain this weight loss over time.
Those in the intensive lifestyle intervention group met regularly with a lifestyle counselor in both group and individual sessions. They were given specific caloric consumption and exercise goals, were encouraged to maintain a diet and exercise diary, and were taught behavioral skills such as problem solving and goal setting. After the first year, participants met individually with a lifestyle counselor at least once per month, were contacted by phone or email at least once per month, and were invited to attend additional group classes. Those in the diabetes support and education group were invited to several group sessions each year that focused on diet, physical activity, or social support.
Lifestyle Intervention Group Achieves Greater Weight Loss
Over the first 4 years of Look AHEAD, participants in both groups showed positive changes in their health. On average, across all 4 years, participants in the intensive lifestyle intervention group lost significantly more weight than participants in the diabetes support and education group. Members of the lifestyle group lost 6.2 percent of their initial body weight on average, and members of the support and education group lost 0.9 percent of their initial body weight.
The intensive intervention group also experienced greater improvements in fitness and in their levels of blood glucose, blood pressure, HDL cholesterol, and triglycerides. The diabetes support group showed larger reductions in LDL cholesterol, a change associated with the increased use of cholesterol-lowering medications in this group.
“This important study shows that lifestyle changes have long-term favorable effects on diabetes control and cardiovascular disease risk factors in overweight or obese individuals with type 2 diabetes,” said Griffin P. Rodgers, M.D., M.A.C.P., director of the NIDDK.
Follow-up Will Determine Impact and Cost of Intervention
Follow-up of Look AHEAD participants will determine whether improvements in risk factors including blood pressure, lipids, and glucose control can be sustained and whether the intensive lifestyle intervention is effective in reducing the incidence of illness and death due to cardiovascular disease. These results will not be available for several years. Other important study objectives include understanding the impact of weight loss and improved fitness on diabetes complications, general health, quality of life, and psychological outcomes. Researchers also will evaluate the cost and cost-effectiveness of the intensive lifestyle intervention compared with diabetes support and education.
Find more information about the Look AHEAD trial (NCT00017953) at www.lookaheadtrial.org. For a list of centers enrolling patients for diabetes or obesity trials, search for keywords “diabetes” or “obesity” at www.ClinicalTrials.gov.
Visit www.diabetes.niddk.nih.gov for more information about diabetes, diet, and physical activity.
Look AHEAD’s Lifestyle Intervention Group Used Fewer Medications after 1 Year
Researchers reported in the June 2010 issue of Diabetes Care that 1 year after the implementation of the intensive lifestyle intervention, Look AHEAD participants not only improved their CVD risk factors, but also reduced the number and monthly cost of prescribed medications they were taking. At the beginning of the trial, study participants were taking an average of 3.3 medications—costing an estimated $155 each month—to manage blood glucose, blood pressure, and cholesterol levels. At 1 year, participants in the intensive lifestyle intervention group were taking an average of 3.1 medications at an estimated $143 per month, in comparison with the diabetes support and education group’s average of 3.6 medications at an estimated $173 per month. The cost difference was primarily due to reduced use of diabetes medications in the intervention group. The 4-year Look AHEAD study results showed continuing decreased medication use in the intervention group compared with the diabetes support and education group.
NIH Publication No. 11–4562
Page last updated: December 5, 2011