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>

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>

Abstract 14192: Breakfast Consumption is Associated With Weight Loss During an Intensive Lifestyle Intervention for Adults With Overweight/Obesity and Type 2 Diabetes: Results From the Look AHEAD Trial

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Daisy Duan ◽  
Scott J Pilla ◽  
Jeanne M Clark ◽  
Nisa M Maruthur
Keyword(s):  
Physical Activity ◽  
Type 2 Diabetes ◽  
Weight Loss ◽  
Lifestyle Intervention ◽  
Caloric Intake ◽  
Activity Level ◽  
Breakfast Consumption ◽  
Intensive Lifestyle Intervention ◽  
Look Ahead

Background: Breakfast skipping is linked to obesity and related cardiometabolic outcomes in observational studies, but the association between breakfast eating and weight loss is not well-established. We examined if weight loss outcomes in Look AHEAD were related to breakfast consumption frequency (BCF). Methods: We included a subset of participants (n=3862) from the public access dataset of Look AHEAD, an RCT that compared intensive lifestyle intervention (ILI) to diabetes support and education (DSE) control in adults with overweight/obesity and type 2 diabetes. A self-reported questionnaire collected BCF over a 7-day week annually. This value (0-7) was averaged across 4 years of the intervention to calculate an average BCF. We used robust multivariable linear regression analysis to estimate the association between % weight change and 4-year average BCF controlling for baseline sociodemographics, BMI, and diabetes-related variables. In separate models, we adjusted for self-reported caloric intake (n=880) and self-reported physical activity level (n=735) among those with data. Results: 4-year average BCF was similar in DSE (n=1914) and ILI (n=1948) arms, with a median of 7 days (IQR 6-7) for both arms (p=0.11). Each 1 day increase in average BCF was associated with an additional 0.43% weight loss in the ILI arm (p=0.002) but not in the DSE arm (β-coefficient 0.04% weight loss; p=0.73; p-interaction for arm x BCF=0.01). This association in the ILI arm remained significant after adjustment for daily caloric intake (p=0.04) but not after adjustment for physical activity (p=0.16). Conclusions: Breakfast consumption was associated with greater weight loss in subjects who received ILI, which was attenuated after adjustment for caloric intake and physical activity. To optimize weight loss interventions, the relationship between breakfast consumption and other weight loss behaviors should be further explored.

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 Virtual Look AHEAD Program: Initial Support for a Partly Virtualized Intensive Lifestyle Intervention in Type 2 Diabetes

Diabetes Care ◽  
2014 ◽  
Vol 37 (8) ◽  
pp. e169-e170 ◽  
Author(s):  
Geoffrey C. Williams ◽  
Christopher P. Niemiec ◽  
Ari J. Elliot ◽  
Jennifer G. LaGuardia ◽  
Amy A. Gorin ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Lifestyle Intervention ◽  
Intensive Lifestyle Intervention ◽  
Look Ahead ◽  
Initial Support

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

Abstract P249: Differential Response to a Lifestyle Intervention Between Parents and Non-parents

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Carolyn T Bramante ◽  
Rachel L Thornton ◽  
Scott J Pilla ◽  
Nisa Maruthur ◽  
Maya Venkataramani ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Cardiovascular Risk ◽  
Waist Circumference ◽  
Lifestyle Intervention ◽  
Weight Percent ◽  
Cardiovascular Risk Reduction ◽  
Intensive Lifestyle Intervention ◽  
Look Ahead

Background: Understanding and preventing cardiovascular disease among parents is important for reducing intergenerational transfer of cardiovascular disease. Prior research has not examined the effect of lifestyle interventions among parents compared to non-parents. We performed a retrospective analysis of the Look AHEAD (Action for Health in Diabetes) trial to assess outcome differences between participants with children younger than 18 years living in the home (referred to as parents) and those without (referred to as non-parents). Methods: Look AHEAD randomized adults aged 45-75 years with type 2 diabetes and BMI>25kg/m 2 to an intensive lifestyle intervention aimed at weight loss, or to a diabetes support and education (control) arm. We examined effects of the intervention at 12 months on objectively measured change in weight (percent of baseline) and cardiovascular risk factors, and change in self-reported dietary intake. To determine whether parenting modified these outcomes, we used linear regression (continuous outcomes) or logistic regression (categorical outcomes) with a multiplicative interaction term for parenting status and treatment arm, adjusted for sociodemographic and clinical characteristics. Modeled results of the interaction are presented. Results: Among 4,547 participants at baseline, 699 (15%) were parents. Parents were younger than non-parents (54.1 vs 59.0 years, p<0.001); more likely to be black (20.2% vs 15.4%) or Hispanic (19.3% vs 12.5%), p<0.001; and more likely to have a professional degree (6.7% vs 5.0%) or no high school education (8.5% vs 5.7%), p<0.001. Age-adjusted baseline prevalence of chronic disease was similar for parents and non-parents. In response to the intervention (treatment minus control arm), parents lost less weight than non-parents, (-7.1% vs -8.3%, p=0.019); and had less improvement in waist circumference (-5.6cm vs -7.2cm, p=0.008). There were trends towards parents having less improvement in triglycerides (-6.0mg/dl vs -17.7mg/dl, p=0.060) and servings of sweets/fats consumed per day (-0.4 vs -0.6, p=0.055). Conclusions: In a clinical trial of an intensive lifestyle intervention for patients with type 2 diabetes, participants with children living in the home had less favorable response to the intervention for change in weight and waist circumference. More research is needed to understand the association of parenthood with health behaviors to optimize cardiovascular risk reduction interventions for parents.

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