Cited by 2,917Diabetes, Cardiovascular Risks, and LipoproteinsDiabetes Treatment and ManagementCardiovascular Function and Risk Factors

The DOI matches its Crossref record; 27 of the 27 references it cites were found in a registry or an index; 9 of the 12 sources its claims cite were checked for support.

Cardiovascular Effects of Intensive Lifestyle Intervention in Type 2 Diabetes

Open access
The Look AHEAD Research Group·2013·New England Journal of Medicine

Abstract

BACKGROUND: Weight loss is recommended for overweight or obese patients with type 2 diabetes on the basis of short-term studies, but long-term effects on cardiovascular disease remain unknown. We examined whether an intensive lifestyle intervention for weight loss would decrease cardiovascular morbidity and mortality among such patients. METHODS: In 16 study centers in the United States, we randomly assigned 5145 overweight or obese patients with type 2 diabetes to participate in an intensive lifestyle intervention that promoted weight loss through decreased caloric intake and increased physical activity (intervention group) or to receive diabetes support and education (control group). The primary outcome was a composite of death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for angina during a maximum follow-up of 13.5 years. RESULTS: The trial was stopped early on the basis of a futility analysis when the median follow-up was 9.6 years. Weight loss was greater in the intervention group than in the control group throughout the study (8.6% vs. 0.7% at 1 year; 6.0% vs. 3.5% at study end). The intensive lifestyle intervention also produced greater reductions in glycated hemoglobin and greater initial improvements in fitness and all cardiovascular risk factors, except for low-density-lipoprotein cholesterol levels. The primary outcome occurred in 403 patients in the intervention group and in 418 in the control group (1.83 and 1.92 events per 100 person-years, respectively; hazard ratio in the intervention group, 0.95; 95% confidence interval, 0.83 to 1.09; P=0.51). CONCLUSIONS: An intensive lifestyle intervention focusing on weight loss did not reduce the rate of cardiovascular events in overweight or obese adults with type 2 diabetes. (Funded by the National Institutes of Health and others; Look AHEAD ClinicalTrials.gov number, NCT00017953.).

Overview

Integrity signals

Registry

Crossref · 10.1056/nejmoa1212914

Cites

27 of 27 references verified0 citation errors · 0 not checkable

Statistics

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Claims the paper makes

9 of 12 cited sources checked · 7 supported · 0 flagged · accuracy not yet measured

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  • It may state two separate claims as one. 13
  • Probably not a substantial claim. 12
  • The quote only partly states this claim. 2
24 of 24
  • The paper relies on this without support.

    The hazard ratio for the primary outcome is constant over follow-up (proportional hazards).

    “Two-sided p-values were calculated with likelihood-ratio tests from Cox proportional-hazards regression, with models containing terms for clinical site, history of cardiovascular disease, and intervention assignment.”
  • The paper relies on this without support.

    The composite primary outcome (cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, or hospitalized angina) is a valid and sufficient measure of cardiovascular morbidity and mortality.

    “The primary end point was the first post-randomization occurrence of a composite cardiovascular outcome.”
  • The paper relies on this without support.

    Participants lost to follow-up did not differ systematically from those retained in a way that would bias the primary outcome comparison.

    “fewer than 4% of all randomized participants had been lost to follow-up.”
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Cited works that were retracted

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  • Cites a retracted work: 10.1056/nejmc1806491

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    The cited work was retracted; the date of the notice is not on record.

    Cited work 10.1056/nejmc1806491 · retraction date not known · this paper published 2013-07-11

  • Cites a retracted work: 10.1056/nejmoa1200303

    Info

    The cited work was retracted on 2018-06-13 (notice 10.1056/nejmc1806491), not before this paper was published (2013-07-11).

    Cited work 10.1056/nejmoa1200303 · retracted 2018-06-13 · notice 10.1056/nejmc1806491 · this paper published 2013-07-11

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Metadata

Authors
The Look AHEAD Research Group
Affiliations
Brown University (US)
Corresponding author
The Look AHEAD Research Group
Venue
New England Journal of Medicine
Published
2013-07-11
Volume
369
Issue
2
Pages
145-154
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
OpenAlex
W1957007052
Cited by
2,908
References
26
Citations by year
2026: 162 · 2025: 228 · 2024: 201 · 2023: 193 · 2022: 186 · 2021: 217 · 2020: 195 · 2019: 184 · 2018: 226 · 2017: 264 · 2016: 250 · 2015: 251 · 2014: 261 · 2013: 82
FWCI
221.30
Type
journal article
Language
en
Open access
Locations
  • New England Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • U.S. Department of Health and Human Services
  • U.S. Department of Veterans Affairs (M01RR01346)
  • Massachusetts General Hospital (DK57151, UL1-RR024153, DK57219, DK57182, M01RR01066, DK57008, DK57178, DK57154, M01RR00051, DK57136, P30 DK48520, DK57171, DK57177, DK57149, DK57002, M01RR000056, DK56992, DK 046204, M01RR02719, M01RR01346, DK56990, DK57131, M01RR0021140, DK57078, DK57135)
  • Massachusetts Institute of Technology (DK 046204, P30 DK48520, DK57182, DK57154, DK57002, DK57149, DK57178, M01RR01346, DK57135, DK57171, DK57151, DK57078, M01RR02719, UL1 RR 024153, DK57008, M01RR01066, M01RR000056, DK56990, DK57177, DK56992, M01RR0021140, DK57219, DK57136, DK57131, M01RR00051)
  • Johns Hopkins University (M01RR02719)
  • University of Pittsburgh (DK57131, DK57008, DK57154, M01RR01346, M01RR01066, DK57078, DK56990, DK57178, DK57002, DK57177, DK56992, P30 DK48520, DK 046204, M01RR02719, UL1RR024153, DK57151, M01RR0021140, DK57149, M01RR000056, M01RR00051, DK57136, DK57171, DK57219, DK57182, DK57135)
  • National Institutes of Health (M01RR0021140, UL1TR000005, 046204, 5p30dk046204-15, DK48520, DK 046204, DK57002)
  • Centers for Disease Control and Prevention (M01RR02719, M01RR000056, DK57135, DK57154, UL1RR024153, DK57131, M01RR00051, DK 046204, DK57008, M01RR01346, DK56992, M01RR0021140, DK57177, DK57151, P30 DK48520, M01RR01066, DK57182, DK57171, DK56990, DK57136, DK57149, DK57078, DK57219, DK57002, DK57178)
  • National Heart, Lung, and Blood Institute (DK57219, DK57131, DK57154, DK57151, K23HL109235, DK56992, DK57078, DK57177, M01RR0021140, DK 046204, DK57182, DK57002, DK57149, DK57008, DK57135, DK57136, DK57178, DK56990, DK57171)
  • National Institute of Nursing Research (DK57219, DK57008, M01RR0021140, DK57002, DK57177, DK57171, DK57182, DK57135, DK57131, DK 046204, DK57151, DK57136, DK56990, DK57178, DK57078, DK56992, DK57149)
  • National Institute of Diabetes and Digestive and Kidney Diseases (M01RR0021140, DK48520, DK-57171, DK 57136, DK57149, DK 57002, DK57182, DK56990, (DK 046204, DK57008, DK57177, DK 57078, DK57219, U01DK057149, DK-57178, U01DK057151, U01DK057135, U01DK057131, U01DK056990, DK-57135, U01DK057136, DK-56992, DK57154, U01DK057178, U01DK057182, U01DK057078, R24DK084949, U01DK057154, P30DK079637, U01DK057008, U01DK057171, DK57131, U01DK057219, U01DK056992, U01DK057177, P30DK017047, P30DK048520, DK 57151)
  • National Center on Minority Health and Health Disparities (DK57136, DK57171, DK57182, DK57154, DK57177, DK 046204, DK57135, M01RR0021140, DK57008, DK57178, DK57002, DK57151, DK56990, DK57078, DK56992, DK57149, DK57219, DK57131)
  • National Center for Research Resources (M01-RR-0021140, M01RR002719, M01RR000056, M01RR000051, M01RR001066, M01RR001346, UL1RR024153)
  • Office of Research on Women's Health (M01RR02719, DK57008, DK57135, DK56990, DK57002, P30 DK48520, DK57177, DK56992, DK57182, DK57151, DK57149, DK57219, DK57078, M01RR000056, M01RR01346, DK57171, UL1 RR 024153, DK57178, M01RR01066, M01RR00051, DK57154, DK57136, DK57131, DK 046204, M01RR0021140)
  • National Center for Advancing Translational Sciences
  • National Institute on Minority Health and Health Disparities
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
Keywords
type 2 diabetes, intensive lifestyle intervention, weight loss, cardiovascular disease, myocardial infarction, stroke, angina pectoris, diabetes support and education, HbA1c, physical activity, caloric restriction, obesity, Look AHEAD trial
MeSH terms
Adult, Aged, Cardiovascular Diseases, Diabetes Mellitus, Type 2, Diet, Reducing, Female, Glycated Hemoglobin, Humans, Life Style, Male, Middle Aged, Obesity, Risk Factors, Weight Loss, Exercise, Treatment Failure, Overweight, Kaplan-Meier Estimate

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