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Cited by 61Diabetes, Cardiovascular Risks, and LipoproteinsDiabetes Treatment and ManagementDiabetes Management and Education

Effects of intensive lifestyle intervention on all-cause mortality in older adults with type 2 diabetes and overweight/obesity: results from the Look AHEAD Study

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Look AHEAD Research Group, Wing, Rena R., Bray, George A., Cassidy-Begay, Maria, Clark, Jeanne M., Coday, Mace, Egan, Caitlin, Evans, Mary +30 more·2022·Diabetes Care
DOI 10.2337/dc21-1805PMC PMC9174966

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Abstract

OBJECTIVE: Look AHEAD, a randomized trial comparing intensive lifestyle intervention (ILI) and diabetes support and education (DSE) (control) in 5,145 individuals with overweight/obesity and type 2 diabetes, found no significant differences in all-cause or cardiovascular mortality or morbidity during 9.6 (median) years of intervention. Participants in ILI who lost ≥10% at 1 year had lower risk of composite cardiovascular outcomes relative to DSE. Since effects of ILI may take many years to emerge, we conducted intent-to-treat analyses comparing mortality in ILI over 16.7 years (9.6 years of intervention and then observation) to DSE. In a secondary exploratory analysis, we compared mortality by magnitude of weight loss in ILI relative to DSE. RESEARCH DESIGN AND METHODS: Primary outcome was all-cause mortality from randomization to 16.7 years. Other outcomes included cause-specific mortality, interactions by subgroups (age, sex, race/ethnicity, and cardiovascular disease history), and an exploratory analysis by magnitude of weight loss in ILI versus DSE as reference. Analyses used proportional hazards regression and likelihood ratio. RESULTS: The incidence of all-cause mortality did not differ significantly in ILI and DSE (549 and 589 participants, respectively) (hazard ratio [HR] 0.91 [95% CI 0.81, 1.02]; P = 0.11). There were no significant differences between treatments in cause-specific mortality or within prespecified subgroups. ILI participants who lost ≥10% at 1 year had a 21% reduced risk of mortality (HR 0.79 [95% CI 0.67, 0.94]; P = 0.007) relative to DSE. CONCLUSIONS: ILI focused on weight loss did not significantly affect mortality risk. However, ILI participants who lost ≥10% had reduced mortality relative to DSE.

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  • Participants who lost ≥10% of weight at 1 year of intervention had a 21% reduced risk of mortality (HR 0.79; 95% CI 0.67-0.94; P = 0.007).

    “Additional analyses 16.7 years after the start of the study (9.6 years of intervention and then observation) revealed that participants who lost ≥10% of weight at 1 year of intervention had a 21% reduced risk of mortality (HR 0.79; 95% CI, 0.67-0.94;P = 0.007).58”

    From 2023 ESC guidelines for the management of cardiovascular disease in patients with diabetes. (2023) · cites this paper as [58]

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Authors
Look AHEAD Research Group, Wing, R. R., Bray, G. A., Cassidy-Begay, M., Clark, J. M., Coday, M., Egan, C., Evans, M., Foreyt, J. P., Glasser, S., Gregg, E. W., Hazuda, H. P., Hill, J. O., Horton, E. S., Isaac, J. C., Jakicic, J. M., Jeffery, R. W., Johnson, K. C., Kahn, S. E., Kritchevsky, S., Lewis, E., Maruthur, N. M., J. Maschak-Carey, B., Nathan, D. M., Patricio, J., Peters, A., Pi-Sunyer, X., Reboussin, D., Ryan, D. H., Ruelas, V., Steinburg, H., Toledo, K., Wadden, T. A., Wagenknecht, L. E., Wesche-Thobaben, J., Wyatt, H., Yanovski, S. Z., & Zhang, P.
ORCID
Venue
Diabetes Care
Publisher
American Diabetes Association
Published
2022-03-21
Volume
45
Issue
5
Pages
1252-1259
ISSN
0149-5992 (ISSN-L)
DOI
10.2337/dc21-1805
PMC
PMC9174966
OpenAlex
W4221013828
Cited by
61
References
40
Citations by year
2026: 13 · 2025: 13 · 2024: 13 · 2023: 10 · 2022: 12
FWCI
8.89
Type
journal article
Language
en
Open access
Licence
www.diabetesjournals.org/content/license (vor)
Locations
  • Diabetes Care (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Massachusetts General Hospital (DK57151, UL1-RR024153, DK57219, M01RR01066, DK57008, DK57178, DK57154, M01RR00051, DK57136, P30 DK48520, RR025758-04, DK57171, DK57177, DK57149, DK57002, M01RR000056, DK56992, DK 046204, M01RR02719, DK56990, DK57131, M01RR0021140, DK57078, DK57135)
  • Brown University
  • Massachusetts Institute of Technology (DK 046204, P30 DK48520, DK57154, DK57002, DK57149, RR025758-04, DK57178, DK57135, DK57171, DK57151, DK57078, M01RR02719, UL1 RR 024153, DK57008, M01RR01066, M01RR000056, DK56990, DK57177, DK56992, M01RR0021140, DK57219, DK57136, DK57131, M01RR00051)
  • University of Pennsylvania
  • Harvard Catalyst (DK57131, RR-025758-04, DK57008, DK57178, M01RR0021140, RR025758, DK57219, M01RR01066, DK56992, M01RR00051, DK57078, DK57135, DK57171, UL1 RR 024153, DK57002, DK 046204, DK57154, DK57177, DK57136, DK57151, P30 DK48520, DK56990, M01RR02719, M01RR000056, DK57149)
  • Johns Hopkins University (M01RR02719)
  • University of Pittsburgh (DK57131, DK57008, DK57154, RR025758-04, M01RR01066, DK57078, DK56990, DK57178, DK57002, DK57177, DK56992, P30 DK48520, DK 046204, M01RR02719, UL1RR024153, DK57151, M01RR0021140, DK57149, M01RR000056, M01RR00051, DK57136, DK57171, DK57219, DK57135)
  • Imperial College London
  • National Institutes of Health (M01RR0021140, 046204, 5p30dk046204-15, DK48520, RR025758-04, DK 046204, DK57002)
  • Centers for Disease Control and Prevention (M01RR02719, M01RR000056, DK57135, DK57154, UL1RR024153, DK57131, RR025758-04, M01RR00051, DK 046204, DK57008, DK56992, M01RR0021140, DK57177, DK57151, P30 DK48520, M01RR01066, DK57171, DK56990, DK57136, DK57149, DK57078, DK57219, DK57002, DK57178)
  • Wake Forest School of Medicine
  • National Institute on Aging (AG058571, R01AG058571)
  • National Heart, Lung, and Blood Institute (DK57219, M01RR02719, DK57131, DK57154, DK57151, DK56992, DK57078, RR025758-04, DK57177, M01RR0021140, DK 046204, DK57002, DK57149, M01RR01066, DK57008, DK57135, P30 DK48520, DK57136, DK57178, DK56990, DK57171, M01RR00051)
  • National Institute of Nursing Research (DK57219, DK57008, M01RR0021140, DK57002, DK57177, RR025758-04, M01RR01066, DK57171, DK57135, DK57131, DK 046204, DK57151, P30 DK48520, M01RR00051, DK57136, DK56990, DK57178, DK57078, DK56992, DK57149, M01RR02719)
  • National Institute of Diabetes and Digestive and Kidney Diseases (M01RR0021140, DK48520, DK-57171, DK 57136, DK57149, DK 57002, DK56990, (DK 046204, M01RR01066, DK57008, DK57177, DK 57078, DK57219, U01DK057149, DK-57178, U01DK057151, U01DK057135, U01DK057131, U01DK056990, DK-57135, M01RR-00051, U01DK057136, DK-56992, DK57154, U01DK057178, U01DK057182, U01DK057078, M01RR02719, U01DK057154, U01DK057008, U01DK057171, DK57131, U01DK057002, U01DK057219, RR025758-04, U01DK056992, U01DK057177, P30DK048520, DK 57151, P30-DK 48520)
  • National Center for Research Resources (M01RR002719, M01RR000056, UL1RR025758, M01RR000051, M01RR001066, M01RR001346, UL1RR024153)
  • Office of Research on Women's Health (M01RR02719, DK57008, DK57135, DK56990, DK57002, P30 DK48520, DK57177, DK56992, DK57151, DK57149, DK57219, DK57078, M01RR000056, DK57171, UL1 RR 024153, DK57178, M01RR01066, M01RR00051, RR025758-04, DK57154, DK57136, DK57131, DK 046204, M01RR0021140)
  • 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 › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
Keywords
intensive lifestyle intervention, type 2 diabetes, obesity, overweight, all-cause mortality, weight loss, Look AHEAD trial, diabetes support and education, cardiovascular mortality, cause-specific mortality, older adults

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