Diabetes Lifestyle Intervention Does Not Reduce Heart Attack Or Stroke Risk

A long-term, intensive lifestyle intervention program for type 2 diabetes patients that focused on weight loss and exercise did not reduce the risk of stroke or heart attacks, researchers involved in the "Look AHEAD" trial explained at the American Diabetes Association's 73rd Scientific Sessions, Chicago, Illinois.

However, the program improved patients' physical quality of life, reduced incidence and severity of depressive symptoms, lowered medical costs because of fewer hospitalizations, outpatient care and medications, and also reduced *microvascular complications.

* Microvascular complications are diseases of the finer blood vessels, including capillaries. In diabetes, examples include neuropathy that can result in loss of sensation and the development of foot ulcers.

Look AHEAD, funded by National Institute of Diabetes and Digestive Kidney Diseases (NIDKK), is a randomized trial carried out in 16 centers across America. It involves over 5,000 people aged between 45 and 76, all of them overweight/obese and diagnosed with type 2 diabetes.

Participants were randomly selected into one of two intervention groups:

• The Intensive Lifestyle Intervention Group - involved exercise and weight loss
• The Diabetes Support and Education Group - involved three sessions with a counselor annually on physical activity, nutrition and social support

Rena Wing, PhD, professor of Psychiatry and Human Behavior at Alpert Medical School of Brown University in Providence, R.I., and chair of the Look AHEAD trial, said:

"Participants were followed for up to 11.5 years, with a median follow-up of 9.6 years at the time the intervention ended. The primary goal was to determine whether the intensive intervention would reduce the risk of cardiovascular mortality and morbidity."

Those in the Intensive Lifestyle Intervention Group lost 8.6% of body weight at first, and then managed to maintain a loss of 6% throughout the follow-up period - a better result than the researchers had expected. Despite this weight loss, their risk of cardiovascular morbidity or mortality was no different from the other group, and their level of LDL-cholesterol ("bad" cholesterol) was also similar.

The participants in the Diabetes Support and Education Group lost 0.7% of body weight initially and then maintained a 3.5% weight loss to the end of the intervention.

The researchers explained that several factors might have caused the disappointing results. Most people had expected those in the Intensive Lifestyle Intervention Group to have considerably lower risks of heart attack and stroke. The greater usage of statins in the Diabetes Support and Education Group could be one factor.

Wing and team said they cannot rule out the possibility that greater weight loss might impact cardiovascular risk.

Intensive Lifestyle Intervention provided some important benefits

When compared to those in the Diabetes Support and Education Group, those in the Intensive Lifestyle Intervention Group experienced the following benefits:

• A lower risk of kidney disease
• A lower risk of depressive symptoms
• A lower risk of retinopathy
• A better physical quality of life
• Lower hospital and medical costs
• Reductions in A1C

Griffin P. Rodgers, MD, director of the National Institute of Diabetes and Digestive and Kidney Diseases, said:

"This study shows that overweight and obese adults with type 2 diabetes can lose weight and keep it off with many important health benefits. It reinforces the recommendation that overweight and obese people with type 2 diabetes should increase their physical activity levels and lose weight to improve their health."

Researchers from Emory University in Atlanta, Georgia, explained at the same ADA Scientific Sessions in Chicago that health care providers can motivate patients to change their lifestyles and improve their health. They reported on 400,000 participants in the MOVE! Program which took place at VA Medical Centers throughout the country.

Written by Christian Nordqvist

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