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
Open accessPreprint — published as 10.2337/dc21-1805 · Paper page
Abstract
Background. Look AHEAD, a randomized trial comparing intensive lifestyle intervention (ILI) and diabetes support and education (DSE) (control) in 5145 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. Objective: 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 year 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. Methods. Primary outcome was all-cause mortality from randomization to 16.7 years. Other outcomes included cause-specific mortality, interactions by sub-groups (age, sex, race/ethnicity, CVD history) and an exploratory analysis by magnitude of weight loss in ILI vs 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); 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, CI 0.67,0.…
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Progressive metabolic benefits were seen with greater degrees of weight loss from >5% to ≥15%.
“Progressive metabolic bene fi ts were seen with greater degrees of weight loss from > 5% to $ 15%”
An overall suggestion that ≥10% weight loss may be required to see benefits for CVD events and mortality rate and other complications, such as nonalcoholic steatohepatitis.
“with an overall suggestion that $ 10% weight loss may be required to see benefi ts for CVD events and mortality rate and other complications, such as nonalcoholic steatohepatitis (50,90,92 -95).”
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Davies, M. J., Aroda, V. R., Collins, B. S., Gabbay, R. A., Green, J., Maruthur, N. M., Rosas, S. E., Del Prato, S., Mathieu, C., Mingrone, G., et al. (2022) · Diabetes Care · doi:10.2337/dci22-0034 · Cited by 2,104 · see citing works
Weight Change During the Postintervention Follow-up of Look AHEAD
Wing, R. R., Neiberg, R. H., Bahnson, J. L., Clark, J. M., Espeland, M. A., Hill, J. O., Johnson, K. C., Knowler, W. C., Olson, K., Steinburg, H., et al. (2022) · Diabetes Care · doi:10.2337/dc21-1990 · Cited by 14 · see citing works
Self-citation
- Authors
- Wing, R. R., Clark, J. M., Gregg, E. W., Kritchevsky, S. B., Lewis, C. E., Pi-Sunyer, F. X., Reboussin, D. M., Wadden, T. A., Wagenknecht, L. E., Yanovski, S. Z., & Group, T. L. A. R.
- Affiliations
- Harvard University (US)
- ORCID
- Publisher
- American Diabetes Association
- Published
- 2022-03-21
- OpenAlex
- W4293337152
- Cited by
- 2
- References
- 0
- Citations by year
- 2022: 2
- Type
- other
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Funders
- U.S. Department of Veterans Affairs (M01RR01346)
- LifeScan (RR025758-04, DK 046204, M01RR01066, M01RR000056, M01RR00051, M01RR01346, M01RR0021140, UL1 RR 024153, M01RR02719, P30 DK48520)
- New York City Department of Health and Mental Hygiene
- Massachusetts General Hospital (UL1-RR024153, M01RR01066, M01RR00051, P30 DK48520, RR025758-04, M01RR000056, DK 046204, M01RR02719, M01RR01346, M01RR0021140)
- University of Southern California
- Massachusetts Institute of Technology (DK 046204, P30 DK48520, RR025758-04, M01RR01346, M01RR02719, UL1 RR 024153, M01RR01066, M01RR000056, M01RR0021140, M01RR00051)
- Wake Forest University
- University of Minnesota
- Harvard Catalyst (RR-025758-04, M01RR0021140, RR025758, M01RR01066, M01RR00051, UL1 RR 024153, DK 046204, P30 DK48520, M01RR01346, M01RR02719, M01RR000056)
- University of Washington
- Joslin Diabetes Center
- Johns Hopkins University (M01RR02719)
- University of Pittsburgh (M01RR01346, RR025758-04, M01RR01066, P30 DK48520, DK 046204, M01RR02719, UL1RR024153, M01RR0021140, M01RR000056, M01RR00051)
- Deutsches Krebsforschungszentrum (M01RR000056)
- National Institutes of Health (M01RR0021140, 046204, DK48520, RR025758-04, DK 046204)
- Centers for Disease Control and Prevention (M01RR02719, M01RR000056, UL1RR024153, RR025758-04, M01RR00051, DK 046204, M01RR01346, M01RR0021140, P30 DK48520, M01RR01066)
- Health Science Center, University of Tennessee
- University of Texas Health Science Center at San Antonio
- Anschutz Medical Campus, University of Colorado
- National Heart, Lung, and Blood Institute (M01RR02719, RR025758-04, M01RR01346, M01RR0021140, DK 046204, M01RR01066, P30 DK48520, M01RR00051)
- National Institute of Nursing Research (M01RR01346, M01RR0021140, RR025758-04, M01RR01066, DK 046204, P30 DK48520, M01RR00051, M01RR02719)
- National Institute of Diabetes and Digestive and Kidney Diseases (M01RR0021140, DK48520, (DK 046204, M01RR01066, M01RR-00051, M01RR02719, M01RR01346, RR025758-04, P30DK048520, P30-DK 48520)
- National Center on Minority Health and Health Disparities (M01RR01066, M01RR00051, M01RR02719, DK 046204, M01RR0021140, P30 DK48520, M01RR01346, RR025758-04)
- National Center for Research Resources (M01RR002719, M01RR000056, M01RR000051, M01RR001066, M01RR001346, UL1RR024153)
- Office of Research on Women's Health (M01RR02719, P30 DK48520, M01RR000056, M01RR01346, UL1 RR 024153, M01RR01066, M01RR00051, RR025758-04, 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, older adults, long-term follow-up
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