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Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes

Published on Jan 1, 2013in The New England Journal of Medicine70.67
· DOI :10.1056/NEJMoa1212914
Rena R. Wing12
Estimated H-index: 12
,
Paula Bolin5
Estimated H-index: 5
(NIH: National Institutes of Health)
+ 41 AuthorsSusan Z. Yanovski14
Estimated H-index: 14
(NIH: National Institutes of Health)
Sources
Abstract
Look AHEAD (Action for Health in Diabetes) was a randomized controlled trial that examined the impact of long-term participation in an intensive weight loss intervention on cardiovascular disease (CVD) morbidity and mortality in people with type 2 diabetes (T2D). The results from this trial suggest that intensive lifestyle interventions are effective in helping patients to achieve management of cardiovascular risk factors and reducing the need to initiate medication usage to manage these conditions, though the benefits in terms of the prevention of CVD morbidity and mortality beyond those achieved through aggressive medical management of hypertension and dyslipidemia is not clear. Additional benefits of participation in an intensive lifestyle intervention such as lowered chronic kidney disease risk, blood pressure, medication usage, improved sleep apnea, and partial remission of diabetes are discussed.
  • References (93)
  • Citations (1324)
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References93
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#1W. Jack Rejeski (Wake Forest University)H-Index: 60
#2George A. Bray (Pennington Biomedical Research Center)H-Index: 120
Last. Edward H. Ip (Wake Forest University)H-Index: 29
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Type 2 diabetes mellitus (T2DM) is a serious threat to public health both in the United States (1,2) and globally (3). T2DM is largely a disease of obesity and aging (4), and its prevalence is expected to increase in the United States over the next two decades as a result of our overweight and aging population (5,6). The combined effect of T2DM and aging on physical functioning (PF) threatens independence of older adults (7), compromises glucose storage and clearance via loss of muscle mass (8),...
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#1Shelley McGuire (WSU: Washington State University)H-Index: 18
1,089 CitationsSource
#1Richard R. RubinH-Index: 40
#2Thomas A. WaddenH-Index: 106
Last. Ping ZhangH-Index: 39
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OBJECTIVE: We examined the effects of an intensive lifestyle intervention (ILI), compared with a diabetes support and education (DSE) control intervention, on long-term changes in depression symptoms, antidepressant medication (ADM) use, and health-related quality of life (HRQoL) in overweight/obese individuals with type 2 diabetes. RESEARCH DESIGN AND METHODS: Look AHEAD was a multisite randomized controlled trial of 5,145 overweight/obese participants assigned to ILI (designed to produce weigh...
96 CitationsSource
#1Bethany Barone Gibbs (Johns Hopkins University)H-Index: 15
#2Frederick L. Brancati (Johns Hopkins University)H-Index: 89
Last. Jeanne M. Clark (Johns Hopkins University)H-Index: 59
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BackgroundBecause lifestyle-induced improvements in cardiovascular risk factors vary substantially across individuals with type 2 diabetes, we investigated the extent to which increases in fitness explain cardiovascular risk factor improvements independent of weight loss in a lifestyle intervention.MethodsWe studied 1-year changes in Look AHEAD, a randomized trial comparing an intensive lifestyle intervention (ILI) to a diabetes support and education (DSE) control group in adults with type 2 dia...
28 CitationsSource
#1Mark A. Espeland (Wake Forest University)H-Index: 72
#2Cora E. Lewis (UAB: University of Alabama at Birmingham)H-Index: 95
Last. Karen C. Johnson (UTHSC: University of Tennessee Health Science Center)H-Index: 70
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Objective To assess whether weight loss improves markers of peripheral artery disease and vascular stenosis. Methods The Action for Health in Diabetes randomized clinical trial compared intensive lifestyle intervention (ILI) for weight loss to a control condition of diabetes support and education (DSE) in overweight or obese adults with type 2 diabetes. Annual ankle and brachial blood pressures over four years were used to compute ankle-brachial indices (ABIs) and to assess interartery blood pre...
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#1Michael G. Perri (UF: University of Florida)H-Index: 54
The eight-year weight loss findings from the Look AHEAD Study (1) reported in this issue of Obesity have important implications for treatment of overweight and obesity. As the largest and longest randomized controlled trial of a behavioral intervention for weight loss, the results from Look AHEAD provide vital information about the short- and long-term effects of an intensive lifestyle intervention for weight management. Over the course of eight years, participants in Look AHEAD’s intensive life...
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#1Richard R. Rubin (JHUSOM: Johns Hopkins University School of Medicine)H-Index: 40
#2Mark Peyrot (Loyola University Maryland)H-Index: 58
Last. William C. Knowler (NIH: National Institutes of Health)H-Index: 91
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OBJECTIVE To study the association of depressive symptoms or antidepressant medicine (ADM) use with subsequent cardiovascular disease (CVD) risk factor status in the Look AHEAD (Action for Health in Diabetes) trial of weight loss in type 2 diabetes. RESEARCH DESIGN AND METHODS Participants ( n = 5,145; age [mean ± SD] 58.7 ± 6.8 years; BMI 35.8 ± 5.8 kg/m 2 ) in two study arms (intensive lifestyle [ILI], diabetes support and education [DSE]) completed the Beck Depression Inventory (BDI), reporte...
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Objective Cardiovascular risk remains high despite statin use. Overweight/obese diabetic persons usually have normal/low LDL-cholesterol but high C-reactive protein (CRP) levels. We aimed to examine the effects of intensive lifestyle intervention for weight loss (ILI) on CRP levels in overweight/obese diabetic individuals by statin use.
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#2David M. Reboussin (Wake Forest University)H-Index: 50
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STUDY OBJECTIVES: To examine whether the initial benefit of weight loss on obstructive sleep apnea (OSA) severity at 1 year is maintained at 4 years. DESIGN: Randomized controlled trial with follow-up at 1, 2, and 4 years. SETTING: 4 Look AHEAD clinical centers. PARTICIPANTS: Two hundred sixty-four obese adults with type 2 diabetes and OSA. INTERVENTIONS: Intensive lifestyle intervention with a behavioral weight loss program or diabetes support and education. MEASUREMENTS: Change in apnea-hypopn...
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