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Evid Based Nurs 11:16 doi:10.1136/ebn.11.1.16
  • Treatment

An intensive lifestyle intervention reduced weight and cardiovascular disease risk factors in overweight and obese people with type 2 diabetes

M Espeland

Correspondence to: Dr M Espeland, Wake Forest University School of Medicine, Winston-Salem, NC, USA; mespelan{at}wfubmc.edu

QUESTION

In overweight or obese people with type 2 diabetes, does an intensive lifestyle intervention reduce weight and cardiovascular disease risk factors?

METHODS

Design:

randomised controlled trial (Action for Health in Diabetes [Look AHEAD] trial).

Allocation:

{concealed}.*

Blinding:

{data collectors and outcome assessors}.*

Follow-up period:

1 year.

Setting:

16 centres in the US.

Participants:

5145 participants 45–75 years of age (mean age 59 y, 60% women) with type 2 diabetes and body mass index >25 kg/m2 or >27 kg/m2 if taking insulin.

Intervention:

intensive lifestyle intervention (n = 2570) or diabetes support and education (n = 2575). The lifestyle intervention combined calorie restriction (⩽30% fat; ⩾15% protein; portion control with liquid meal replacements, frozen entrées, and structured meal plans; and encouragement to lose >10% of body weight); increased moderate-intensity physical activity (PA) (walking or home-based exercise with gradual progression to 175 min/wk); individual and group meetings with registered dietitians, behavioural psychologists, and exercise specialists; and use of orlistat or advanced behavioural strategies if weight or PA goals were not met at 6 months. Support and education comprised 3 informational group meetings to discuss diet, PA, and social support.

Outcomes:

included weight loss; use of medications; haemoglobin A1c (HbA1c), low-density (LDL) and high-density lipoprotein (HDL) cholesterol, and triglyceride concentrations; and systolic blood pressure (BP).

Participant follow-up:

96%.

MAIN RESULTS

At the 1-year interim analysis, the lifestyle intervention group had greater weight loss, reduction in medication use, and improvements in HbA1c, triglyceride, LDL and HDL cholesterol concentrations, and systolic BP than the support and education group (table).

CONCLUSION

An intensive lifestyle intervention reduced weight and cardiovascular disease risk factors in overweight and obese people with type 2 diabetes in the interim analysis at 1 year.

*Information provided by author.

A modified version of this abstract appears in Evidence-Based Medicine.

ABSTRACTED FROM

Pi-Sunyer X, Blackburn G, Brancati FL, et al. Reduction in weight and cardiovascular disease risk factors in individuals with type 2 diabetes: one-year results of the Look AHEAD trial. Diabetes Care 2007;30:1374–83.

Clinical impact ratings: Cardiology 6/7; Endocrinology 6/7; General/Internal medicine 5/7; Obesity 6/7

An intensive lifestyle intervention v diabetes support and education in overweight or obese people with type 2 diabetes

Footnotes

  • Source of funding: National Institutes of Health.

Commentary

The Look AHEAD trial by Pi-Sunyer et al provides compelling evidence that an intensive lifestyle intervention can not only lead to substantial weight loss and higher fitness but also improvement in cardiac risk factors and reduction in the need for diabetes and cardiac medications at 1 year. These outcomes are more pronounced than in earlier studies1 and are likely because of the intensive nature of the intervention. The findings highlight the importance of using individual and group mechanisms to bring about behavioural change, as well as the need for multidisciplinary interventions. Given what is known about the importance of group support, maintenance of behavioural change over the full duration of follow-up (∼12 y) will be challenging, despite ongoing, but less frequent, individual contacts and sporadic refresher groups.

Nurses have a critical role in the education and ongoing management of patients with diabetes. A recent survey by the Diabetes Attitudes Wishes and Needs Study showed that nurses were willing to take on more responsibility for diabetes management, and both nurses and physicians agreed that nurses should take on a larger role.2 The Look AHEAD trial provides a model for clinical nursing practice and future translational research.

References

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