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Weight loss does not lower heart risk from T2DM

Study report other important health benefits of the lifestyle intervention
Dr Rena Wing, chair of the Look AHEAD study

Intensive diet and exercise programme resulting in weight loss does not reduce cardiovascular events in type 2 diabetics, according to a the Look AHEAD (Action for Health in Diabetes) study.

Although the intervention did not reduce cardiovascular events, Look AHEAD reported other important health benefits of the lifestyle intervention, including decreasing sleep apnoea, reducing the need for diabetes medications, helping to maintain physical mobility, and improving quality of life.

“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."

Researchers at 16 centres across the US worked with 5,145 people; half were randomly assigned to receive an intensive lifestyle intervention and the other half to a general programme of diabetes support and education. Participants were 45 to 76 years old when they enrolled in the study. Sixty percent were women. More than 375 were from racial and ethnic minority groups.

Both groups received routine medical care from their own health care providers.

The study was designed to assess whether a lifestyle intervention resulting in weight loss would reduce rates of heart disease, stroke, and cardiovascular-related deaths in overweight and obese people with type 2 diabetes.

In September 2012, the National Institutes for Health stopped the intervention arm, following a recommendation based on the study's data and safety monitoring board. The independent advisory board, charged with monitoring the study data and safety of participants, found that the intensive lifestyle did no harm but did not decrease occurrence of cardiovascular events, the primary study goal. At the time, participants had been in the intervention for up to 11 years.

The data is currently being analysed to fully understand the cardiovascular disease results. Investigators are preparing a report of the findings for a peer-reviewed publication.

Participants in the intervention group lost an average of more than 8% of their initial body weight after one year of intervention and they maintained an average weight loss of nearly 5% at four years. Participants in the diabetes support and education group lost about 1% of their initial weight after one and four years.

Because there was little chance of finding a difference in cardiovascular events between the groups with further intervention, the board recommended stopping the intensive lifestyle intervention, but encouraged the study to continue following all Look AHEAD participants to identify longer-term effects of the intervention.

"The intervention group did not have fewer cardiovascular events than the group receiving general diabetes support and education, but one positive factor we saw was that both groups had a low number of cardiovascular events compared to previous studies of people with diabetes," said Dr Mary Evans, director of Special Projects in Nutrition, Obesity, and Digestive Diseases within the NIH's National Institute of Diabetes and Digestive and Kidney Diseases the study's primary sponsor.


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