Association of an intensive lifestyle intervention with remission of type 2 diabetes (Look AHEAD)

Gregg EW, Chen H, Wagenknecht LE, et al; for the Look AHEAD Research Group. Association of intensive lifestyle intervention with remission of type 2 diabetes. JAMA. 2012;308:2489-2496. 

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Background  

Look AHEAD (Action for Health in Diabetes) assessed the long-term effects (up to 11.5 years) of an intensive lifestyle intervention over 4 years on cardiovascular morbidity and mortality among 5,145 overweight/obese individuals with type 2 diabetes.1 

An analysis of Look AHEAD at 4 years showed that the percent reduction from initial weight was -4.7% in the intensive lifestyle intervention group and -1.1% in the diabetes support and education group (P<0.001).2 Subjects in the intensive lifestyle intervention group had greater weight loss than those in the diabetes support and education group at all annual assessments at years 1-4. (For more information, click here) 

Look AHEAD Ancillary Observational Analysis 

This ancillary observational analysis of Look AHEAD examined the association of a long-term intensive lifestyle intervention with remission (partial or complete) of type 2 diabetes. A total of 4,530 Look AHEAD participants were included in the analysis (n=2,241 in lifestyle group n=2,262 in diabetes support and education group). Median time since diabetes diagnosis was 5 years; mean body mass index was 35.8 kg/m2(Click here for slide.)  

Results  

Participants assigned to intensive lifestyle intervention were significantly more likely to experience partial or complete remission of type 2 diabetes than counterparts assigned to diabetes support and education.

In the first year, the prevalence of type 2 diabetes remission was 11.5% for the lifestyle group (95% CI, 10.1%-12.8%) compared with 2.0% in the diabetes support and education group (95% CI, 1.4%-2.6%). At Year 4, the rates were 7.3% (95% CI, 6.2%-8.4%) and 2.0 (95% CI, 1.5%-2.7%), respectively. (P<0.001 for each year.) (Click here for slide.)  

Among participants who experienced partial or complete type 2 diabetes remission, one-third in the intensive lifestyle group returned to a clinical diabetes status each year: 33.1% (95% CI, 27.4%-39.3%) in Year 2; 33.8% (95% CI, 27.9%-40.2%) in Year 3; and 31.6% (95% CI, 25.3%-38.6%) in Year 4. Approximately one-half of participants in the diabetes support and education group returned to a clinical diabetes status each year: 52.4% (95% CI, 42.2%-62.3%) in Year 2; 45.9% (95% CI, 35.6%-56.6%) in Year 3; and 43.8% (95% CI, 32.9%-55.4%) in Year 4. (Click here for slide.) 

Participants in the intensive lifestyle group were more likely to experience continuous, sustained remission of type 2 diabetes: 9.2% (95% CI, 7.9%-10.4%) had at least a 2-year remission; 6.4% (95% CI, 5.7%-7.4%) had at least a 3-year remission; and 3.5% (95% CI, 2.7%-4.3%) had at least a 4-year remission. Rates for the diabetes support and education group: 1.7% (95% CI, 1.2%-2.3%; P<0.001) 2-year; 1.3% (95% CI, 0.8%-1.7%) 3-year; and 0.5% (95% CI, 0.2%-0.8%; P=0.02) for 4-year remission. Any remission of type 2 diabetes during the first year of the study was significantly associated with shorter diabetes duration, low body mass index, low baseline A1C, no insulin use, and greater 1-year weight loss. (Click here for slide.) 

1. Ryan DH, Espeland MA, Foster GD, et al; for the Look AHEAD Research Group. Look AHEAD (Action for Health in Diabetes): design and methods for a clinical trial of weight loss for the prevention of cardiovascular disease in type 2 diabetes. Control Clin Trials. 2003;24(5):610-628.

2. The Look AHEAD Research Group. Long-term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes mellitus: four-year results of the Look AHEAD trial. Arch Intern Med. 2010;170(17):1566-1575.

Related content: 

Expert commentary: Anne Peters, MD, on the lack of benefit conferred by lifestyle modifications on CV events in Look AHEAD  

Slide: Look AHEAD: Design   

Slide: Look AHEAD: 4-Year Data Analysis 

Slide:Look AHEAD: Lifestyle Interventions  

Slide: Look AHEAD at 4 Years: Weight Reduction 

Slide: Look AHEAD at 4 Years: Percent Weight Reduction and Gain  

Slide: Look AHEAD at 4 Years: Weight Reduction By Subgroup, Insulin Use  

Slide: Look AHEAD at 4 Years: Weight Maintenance 

Slide: Look AHEAD at 1 Year: Additional Results  

Slide: Look AHEAD at 1 Year: Change in Fitness Levels  

Slide: Look AHEAD at 1 Year: Change in Body Weight 

Slide: Look AHEAD at 1 Year: Interventions 

Slide: Look AHEAD at 1 Year: Interim Results 

Clinical Insights® in Diabetes Newsletter: December 2011   

 

February 2013

This overview was created by KnowledgePoint360 Group, LLC, and was not associated with funding via an educational grant or a promotional/commercial interest.

Last Modified: 8/5/2014