Evidence-based lifestyle interventions for obesity and Type 2 diabetes: The Look AHEAD intensive lifestyle intervention as exemplar.

2016 ◽  
Vol 71 (7) ◽  
pp. 614-627 ◽  
Author(s):  
Delia Smith West ◽  
Sandra M. Coulon ◽  
Courtney M. Monroe ◽  
Dawn K. Wilson
Keyword(s):  
Type 2 Diabetes ◽  
Lifestyle Intervention ◽  
Evidence Based ◽  
Lifestyle Interventions ◽  
Intensive Lifestyle Intervention ◽  
Look Ahead ◽  
The Look

scholarly journals Impact of intensive lifestyle intervention on preference-based quality of life in type 2 diabetes: Results from the Look AHEAD trial

Obesity ◽  
2016 ◽  
Vol 24 (4) ◽  
pp. 856-864 ◽  
Author(s):  
Ping Zhang ◽  
Don Hire ◽  
Mark A. Espeland ◽  
William C. Knowler ◽  
Sheikilya Thomas ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Type 2 Diabetes ◽  
Lifestyle Intervention ◽  
Intensive Lifestyle Intervention ◽  
Look Ahead ◽  
The Look

scholarly journals Intensive Lifestyle Intervention Reduces Urinary Incontinence in Overweight/Obese Men with Type 2 Diabetes: Results from the Look AHEAD Trial

2014 ◽  
Vol 192 (1) ◽  
pp. 144-149 ◽  
Author(s):  
Benjamin N. Breyer ◽  
Suzanne Phelan ◽  
Patricia E. Hogan ◽  
Raymond C. Rosen ◽  
Abbas E. Kitabchi ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Urinary Incontinence ◽  
Lifestyle Intervention ◽  
Intensive Lifestyle Intervention ◽  
Look Ahead ◽  
The Look

scholarly journals Effect of an intensive lifestyle intervention on atrial fibrillation risk in individuals with type 2 diabetes: The Look AHEAD randomized trial

2015 ◽  
Vol 170 (4) ◽  
pp. 770-777.e5 ◽  
Author(s):  
Alvaro Alonso ◽  
Judy L. Bahnson ◽  
Sarah A. Gaussoin ◽  
Alain G. Bertoni ◽  
Karen C. Johnson. ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Type 2 Diabetes ◽  
Randomized Trial ◽  
Lifestyle Intervention ◽  
Intensive Lifestyle Intervention ◽  
Look Ahead ◽  
The Look

scholarly journals Effectiveness of Lifestyle Interventions for Individuals With Severe Obesity and Type 2 Diabetes: Results from the Look AHEAD trial

Diabetes Care ◽  
2011 ◽  
Vol 34 (10) ◽  
pp. 2152-2157 ◽  
Author(s):  
J. L. Unick ◽  
D. Beavers ◽  
J. M. Jakicic ◽  
A. E. Kitabchi ◽  
W. C. Knowler ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Severe Obesity ◽  
Lifestyle Interventions ◽  
Look Ahead ◽  
The Look

P4990Heterogeneity of treatment effects from an intensive lifestyle weight loss intervention on cardiovascular events in patients with type 2 diabetes: data from the Look AHEAD trial

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T I De Vries ◽  
J A N Dorresteijn ◽  
Y Van Der Graaf ◽  
F L J Visseren ◽  
J Westerink
Keyword(s):  
Type 2 Diabetes ◽  
Treatment Effect ◽  
Patient Characteristics ◽  
Treatment Benefit ◽  
Significant Treatment ◽  
Intensive Lifestyle Intervention ◽  
Look Ahead ◽  
The Look

Abstract Background The Action for Health in Diabetes trial (Look AHEAD) randomized overweight and obese patients with type 2 diabetes to either an intensive lifestyle intervention (ILI) or diabetes support and education (DSE). The trial was stopped early for futility after a median follow-up of 9.6 years due to a lack of effect on cardiovascular disease outcomes, despite beneficial effects on metabolic control and cardiovascular risk factors. Subgroup analyses identified no subgroups based on baseline characteristics with a significant treatment effect. However, traditional simple subgroup analyses have several disadvantages compared to a multivariable risk-based approach to identify heterogeneity of treatment effects (HTE). Purpose To explore the possible presence of HTE of an ILI on the occurrence of major cardiovascular events (4-point MACE: nonfatal myocardial infarction, nonfatal stroke, hospitalization for angina, and death from cardiovascular causes) in overweight or obese patients with type 2 diabetes mellitus, and to identify patient characteristics associated with treatment. Methods In 4,901 patients from Look AHEAD, a ridge penalized Cox regression model to predict treatment effect of ILI versus DSE on the risk of MACE was derived including all possible treatment-by-covariate interaction terms. Next, the ability of the model to predict HTE was confirmed by calculating hazard ratios (HR) and absolute risk change in quartiles of predicted treatment effect, thereby leaving randomization intact. Finally, baseline patient characteristics were compared between quartiles of predicted treatment effect. Results During a median follow-up of 9.4 years, 799 events occurred (Fig. 1A). The derived risk model showed good internal calibration, with a C-statistic for discrimination of 0.73 (95% confidence interval [95% CI] 0.71–0.73). The median estimated absolute treatment effect on 10 year risk for MACE with ILI was −1.3% and varied substantially, ranging from −39% to +43% (Fig. 1B). In quartile 1, the quartile with the highest benefit, there was a significant treatment benefit of ILI versus DSE (HR 0.64; 95% CI 0.49–0.83), while there was no effect from treatment in quartiles 2 and 3 (HR 0.81, 95% CI 0.58–1.14, and 1.13, 95% CI 0.80–1.60, respectively), and a detrimental effect in quartile 4 (HR 1.37, 95% CI 1.09–1.73) (Fig. 1C). Patient characteristics most notably associated with higher benefit of ILI were higher age, male sex, higher socio-economic status, no history of cardiovascular disease, no use of insulin, higher blood pressure, lower HbA1c, and the presence of micro-albuminuria but absence of macro-albuminuria. Figure 1 Conclusion This post-hoc analysis of the Look AHEAD trial shows evidence of considerable HTE of an intensive lifestyle intervention aimed at weight loss for reducing MACE. Future research into ILI for MACE risk reduction should be specifically aimed at subgroups of patients with a high likelihood of treatment benefit. Acknowledgement/Funding None

scholarly journals Lifestyle intervention and/or statins for the reduction of C-reactive protein in type 2 diabetes: From the look AHEAD study

Obesity ◽  
2013 ◽  
Vol 21 (5) ◽  
pp. 944-950 ◽  
Author(s):  
L. Maria Belalcazar ◽  
Steven M. Haffner ◽  
Wei Lang ◽  
Ron C. Hoogeveen ◽  
Julia Rushing ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Lifestyle Intervention ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Look Ahead ◽  
The Look

scholarly journals Type 2 Diabetes Subgroups, Risk for Complications, and Differential Effects Due to an Intensive Lifestyle Intervention

2021 ◽  
Author(s):  
Michael P. Bancks ◽  
Haiying Chen ◽  
Ashok Balasubramanyam ◽  
Alain G. Bertoni ◽  
Mark A. Espeland ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Lifestyle Intervention ◽  
Age At Onset ◽  
Caloric Intake ◽  
Diabetes Diagnosis ◽  
Intensive Lifestyle Intervention ◽  
Look Ahead ◽  
Increased Risk ◽  
Differential Risk

<b>Objective:</b> We re-evaluated the Action for Health in Diabetes (Look AHEAD) intervention, incorporating diabetes subgroups, to identify whether intensive lifestyle intervention (ILI) is associated with differential risk for cardiovascular disease (CVD) by diabetes subgroup. <p><b>Research Design and Methods: </b>Look AHEAD randomized 5145 participants, aged 45-76 years, with type 2 diabetes (T2D) and overweight or obesity, to 10 years of ILI or a control condition of diabetes support and education. ILI focused on weight loss through decreased caloric intake and increased physical activity. To characterize diabetes subgroups, we applied k-means clustering to data for age of diabetes diagnosis, body mass index, waist circumference, and glycated hemoglobin. We examined whether relative intervention effects on the trial’s prespecified CVD outcomes varied among diabetes subgroups.</p> <p><b>Results:</b> We characterized four subgroups related to older age at diabetes onset (42% of sample), poor glycemic control (14%), severe obesity (24%), and younger age at onset (20%). We observed interactions (all p<0.05) between intervention and diabetes subgroup for three separate composite cardiovascular outcomes. Randomization to ILI was associated with increased risk for each cardiovascular outcome only among the poor glucose control subgroup (hazard ratios, HR >1.32). Among the three other diabetes subgroups, ILI was not associated with increased risk for CVD.</p> <p><b>Conclusion:</b> Among overweight and obese adults with T2D, a lifestyle intervention was associated with differential risk for CVD that was dependent on diabetes subgroup. Diabetes subgroups may be important to identify the patients who would achieve benefit and avoid harm from an intensive lifestyle intervention.</p>

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