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ADA: Lifestyle Invention Doesn’t Reduce Cardiovascular Events in Type 2 Obese Adults

Lifestyle changes in obese patients with type 2 diabetes can decrease some complications and even medical costs, but….

Results from the Look AHEAD (Action for Health in Diabetes) trial showed that these same lifestyle modifications did not decrease the risk for heart attacks or stroke. Look AHEAD is a randomized trial performed in 16 centers that included more than 5,000 obese adults diagnosed with type 2 diabetes. Patients were randomized into two different groups: the lifestyle group that received altering physical activity and weight loss, and the diabetes support and education group that received physical activity, social support and three counseling sessions per year.

Rena Wing, PhD, chair of the Look AHEAD trial, says, "The primary goal was to determine whether the intensive intervention would reduce the risk of cardiovascular mortality and morbidity."

The weight loss that the participants achieved was better than researchers expected. Again, participants who received rigorous lifestyle modifications did not have a decreased risk of cardiovascular morbidity or mortality or level of LDL cholesterol compared to the diabetes support and education group. There are many reasons for why this may have occurred such as the increased use of medications that lower LDL cholesterol in the diabetes support and education group. It may be possible that participants with greater weight loss may also have decreased cardiovascular complications.

The participants who received intensive lifestyle modifications experienced other benefits when compared to the diabetes education and support group, including decreased depressive symptoms, less self-reported retinopathy, and decreased risk of kidney disease.

Compared to the diabetes support and education group, the intensive lifestyle intervention reduced the average number of hospitalizations per year and the average number of medications per year. Hospitalizations were reduced by 11.9% from 0.193 to 0.17 hospitalizations per year, which translated into savings of $294 per year and $2,600 discounted over 10 years.

Moreover, the number of medications was reduced by 6.3% from 4.9 to 4.6 medications per year, translating into a savings of $278 per year and $2,487 discounted over 10 years. Average costs per year were $8,807 for the control group vs. $8,205 for the intervention group, leading to a significant reduction of $602 per year and $5,378 discounted over 10 years.

Significant reductions in hospitalizations occurred mainly among CV and pulmonary hospitalization, and significant reductions in medications occurred mainly among diabetes, lipid-lowering and antihypertensive medications.

The study ultimately shows that obese or overweight people with type 2 diabetes should increase the amount that they exercise and increase their weight loss.

Gerstein HC. N Engl J Med. 2013;doi:10.1056/NEJMe1306987