Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes

Rena R. Wing, Paula Bolin, Frederick L. Brancati, George A. Bray, Jeanne Clark, Mace Coday, Richard S. Crow, Jeffrey M. Curtis, Caitlin M. Egan, Mark A. Espeland, Mary Evans, John P. Foreyt, Siran Ghazarian, Edward W. Gregg, Barbara Harrison, Helen P. Hazuda, James O. Hill, Edward S. Horton, S. Van Hubbard, John M. Jakicic & 24 others Robert W. Jeffery, Karen C. Johnson, Steven E. Kahn, Abbas E. Kitabchi, William C. Knowler, Cora E. Lewis, Barbara J. Maschak-Carey, Maria G. Montez, Anne Murillo, David M. Nathan, Jennifer Patricio, Anne Peters, Xavier Pi-Sunyer, Henry Pownall, David Reboussin, Judith G. Regensteiner, Amy D. Rickman, Donna H. Ryan, Monika Safford, Thomas A. Wadden, Lynne E. Wagenknecht, Delia S. West, David F. Williamson, Susan Z. Yanovski

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Weight loss is recommended for overweight or obese patients with type 2 diabetes on the basis of short-term studies, but long-term effects on cardiovascular disease remain unknown. We examined whether an intensive lifestyle intervention for weight loss would decrease cardiovascular morbidity and mortality among such patients. METHODS: In 16 study centers in the United States, we randomly assigned 5145 overweight or obese patients with type 2 diabetes to participate in an intensive lifestyle intervention that promoted weight loss through decreased caloric intake and increased physical activity (intervention group) or to receive diabetes support and education (control group). The primary outcome was a composite of death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for angina during a maximum follow-up of 13.5 years. RESULTS: The trial was stopped early on the basis of a futility analysis when the median follow-up was 9.6 years. Weight loss was greater in the intervention group than in the control group throughout the study (8.6% vs. 0.7% at 1 year; 6.0% vs. 3.5% at study end). The intensive lifestyle intervention also produced greater reductions in glycated hemoglobin and greater initial improvements in fitness and all cardiovascular risk factors, except for low-density-lipoprotein cholesterol levels. The primary outcome occurred in 403 patients in the intervention group and in 418 in the control group (1.83 and 1.92 events per 100 person-years, respectively; hazard ratio in the intervention group, 0.95; 95% confidence interval, 0.83 to 1.09; P = 0.51). CONCLUSIONS: An intensive lifestyle intervention focusing on weight loss did not reduce the rate of cardiovascular events in overweight or obese adults with type 2 diabetes. (Funded by the National Institutes of Health and others; Look AHEAD ClinicalTrials.gov number, NCT00017953.)

Original languageEnglish (US)
Pages (from-to)145-154
Number of pages10
JournalNew England Journal of Medicine
Volume369
Issue number2
DOIs
StatePublished - 2013

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Type 2 Diabetes Mellitus
Life Style
Weight Loss
Control Groups
Medical Futility
National Institutes of Health (U.S.)
Glycosylated Hemoglobin A
Energy Intake
LDL Cholesterol
Cause of Death
Hospitalization
Cardiovascular Diseases
Stroke
Myocardial Infarction
Confidence Intervals
Exercise
Morbidity
Education
Mortality

ASJC Scopus subject areas

  • Medicine(all)

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Wing, R. R., Bolin, P., Brancati, F. L., Bray, G. A., Clark, J., Coday, M., ... Yanovski, S. Z. (2013). Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. New England Journal of Medicine, 369(2), 145-154. https://doi.org/10.1056/NEJMoa1212914

Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. / Wing, Rena R.; Bolin, Paula; Brancati, Frederick L.; Bray, George A.; Clark, Jeanne; Coday, Mace; Crow, Richard S.; Curtis, Jeffrey M.; Egan, Caitlin M.; Espeland, Mark A.; Evans, Mary; Foreyt, John P.; Ghazarian, Siran; Gregg, Edward W.; Harrison, Barbara; Hazuda, Helen P.; Hill, James O.; Horton, Edward S.; Van Hubbard, S.; Jakicic, John M.; Jeffery, Robert W.; Johnson, Karen C.; Kahn, Steven E.; Kitabchi, Abbas E.; Knowler, William C.; Lewis, Cora E.; Maschak-Carey, Barbara J.; Montez, Maria G.; Murillo, Anne; Nathan, David M.; Patricio, Jennifer; Peters, Anne; Pi-Sunyer, Xavier; Pownall, Henry; Reboussin, David; Regensteiner, Judith G.; Rickman, Amy D.; Ryan, Donna H.; Safford, Monika; Wadden, Thomas A.; Wagenknecht, Lynne E.; West, Delia S.; Williamson, David F.; Yanovski, Susan Z.

In: New England Journal of Medicine, Vol. 369, No. 2, 2013, p. 145-154.

Research output: Contribution to journalArticle

Wing, RR, Bolin, P, Brancati, FL, Bray, GA, Clark, J, Coday, M, Crow, RS, Curtis, JM, Egan, CM, Espeland, MA, Evans, M, Foreyt, JP, Ghazarian, S, Gregg, EW, Harrison, B, Hazuda, HP, Hill, JO, Horton, ES, Van Hubbard, S, Jakicic, JM, Jeffery, RW, Johnson, KC, Kahn, SE, Kitabchi, AE, Knowler, WC, Lewis, CE, Maschak-Carey, BJ, Montez, MG, Murillo, A, Nathan, DM, Patricio, J, Peters, A, Pi-Sunyer, X, Pownall, H, Reboussin, D, Regensteiner, JG, Rickman, AD, Ryan, DH, Safford, M, Wadden, TA, Wagenknecht, LE, West, DS, Williamson, DF & Yanovski, SZ 2013, 'Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes', New England Journal of Medicine, vol. 369, no. 2, pp. 145-154. https://doi.org/10.1056/NEJMoa1212914
Wing, Rena R. ; Bolin, Paula ; Brancati, Frederick L. ; Bray, George A. ; Clark, Jeanne ; Coday, Mace ; Crow, Richard S. ; Curtis, Jeffrey M. ; Egan, Caitlin M. ; Espeland, Mark A. ; Evans, Mary ; Foreyt, John P. ; Ghazarian, Siran ; Gregg, Edward W. ; Harrison, Barbara ; Hazuda, Helen P. ; Hill, James O. ; Horton, Edward S. ; Van Hubbard, S. ; Jakicic, John M. ; Jeffery, Robert W. ; Johnson, Karen C. ; Kahn, Steven E. ; Kitabchi, Abbas E. ; Knowler, William C. ; Lewis, Cora E. ; Maschak-Carey, Barbara J. ; Montez, Maria G. ; Murillo, Anne ; Nathan, David M. ; Patricio, Jennifer ; Peters, Anne ; Pi-Sunyer, Xavier ; Pownall, Henry ; Reboussin, David ; Regensteiner, Judith G. ; Rickman, Amy D. ; Ryan, Donna H. ; Safford, Monika ; Wadden, Thomas A. ; Wagenknecht, Lynne E. ; West, Delia S. ; Williamson, David F. ; Yanovski, Susan Z. / Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. In: New England Journal of Medicine. 2013 ; Vol. 369, No. 2. pp. 145-154.
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abstract = "BACKGROUND: Weight loss is recommended for overweight or obese patients with type 2 diabetes on the basis of short-term studies, but long-term effects on cardiovascular disease remain unknown. We examined whether an intensive lifestyle intervention for weight loss would decrease cardiovascular morbidity and mortality among such patients. METHODS: In 16 study centers in the United States, we randomly assigned 5145 overweight or obese patients with type 2 diabetes to participate in an intensive lifestyle intervention that promoted weight loss through decreased caloric intake and increased physical activity (intervention group) or to receive diabetes support and education (control group). The primary outcome was a composite of death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for angina during a maximum follow-up of 13.5 years. RESULTS: The trial was stopped early on the basis of a futility analysis when the median follow-up was 9.6 years. Weight loss was greater in the intervention group than in the control group throughout the study (8.6{\%} vs. 0.7{\%} at 1 year; 6.0{\%} vs. 3.5{\%} at study end). The intensive lifestyle intervention also produced greater reductions in glycated hemoglobin and greater initial improvements in fitness and all cardiovascular risk factors, except for low-density-lipoprotein cholesterol levels. The primary outcome occurred in 403 patients in the intervention group and in 418 in the control group (1.83 and 1.92 events per 100 person-years, respectively; hazard ratio in the intervention group, 0.95; 95{\%} confidence interval, 0.83 to 1.09; P = 0.51). CONCLUSIONS: An intensive lifestyle intervention focusing on weight loss did not reduce the rate of cardiovascular events in overweight or obese adults with type 2 diabetes. (Funded by the National Institutes of Health and others; Look AHEAD ClinicalTrials.gov number, NCT00017953.)",
author = "Wing, {Rena R.} and Paula Bolin and Brancati, {Frederick L.} and Bray, {George A.} and Jeanne Clark and Mace Coday and Crow, {Richard S.} and Curtis, {Jeffrey M.} and Egan, {Caitlin M.} and Espeland, {Mark A.} and Mary Evans and Foreyt, {John P.} and Siran Ghazarian and Gregg, {Edward W.} and Barbara Harrison and Hazuda, {Helen P.} and Hill, {James O.} and Horton, {Edward S.} and {Van Hubbard}, S. and Jakicic, {John M.} and Jeffery, {Robert W.} and Johnson, {Karen C.} and Kahn, {Steven E.} and Kitabchi, {Abbas E.} and Knowler, {William C.} and Lewis, {Cora E.} and Maschak-Carey, {Barbara J.} and Montez, {Maria G.} and Anne Murillo and Nathan, {David M.} and Jennifer Patricio and Anne Peters and Xavier Pi-Sunyer and Henry Pownall and David Reboussin and Regensteiner, {Judith G.} and Rickman, {Amy D.} and Ryan, {Donna H.} and Monika Safford and Wadden, {Thomas A.} and Wagenknecht, {Lynne E.} and West, {Delia S.} and Williamson, {David F.} and Yanovski, {Susan Z.}",
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T1 - Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes

AU - Wing, Rena R.

AU - Bolin, Paula

AU - Brancati, Frederick L.

AU - Bray, George A.

AU - Clark, Jeanne

AU - Coday, Mace

AU - Crow, Richard S.

AU - Curtis, Jeffrey M.

AU - Egan, Caitlin M.

AU - Espeland, Mark A.

AU - Evans, Mary

AU - Foreyt, John P.

AU - Ghazarian, Siran

AU - Gregg, Edward W.

AU - Harrison, Barbara

AU - Hazuda, Helen P.

AU - Hill, James O.

AU - Horton, Edward S.

AU - Van Hubbard, S.

AU - Jakicic, John M.

AU - Jeffery, Robert W.

AU - Johnson, Karen C.

AU - Kahn, Steven E.

AU - Kitabchi, Abbas E.

AU - Knowler, William C.

AU - Lewis, Cora E.

AU - Maschak-Carey, Barbara J.

AU - Montez, Maria G.

AU - Murillo, Anne

AU - Nathan, David M.

AU - Patricio, Jennifer

AU - Peters, Anne

AU - Pi-Sunyer, Xavier

AU - Pownall, Henry

AU - Reboussin, David

AU - Regensteiner, Judith G.

AU - Rickman, Amy D.

AU - Ryan, Donna H.

AU - Safford, Monika

AU - Wadden, Thomas A.

AU - Wagenknecht, Lynne E.

AU - West, Delia S.

AU - Williamson, David F.

AU - Yanovski, Susan Z.

PY - 2013

Y1 - 2013

N2 - BACKGROUND: Weight loss is recommended for overweight or obese patients with type 2 diabetes on the basis of short-term studies, but long-term effects on cardiovascular disease remain unknown. We examined whether an intensive lifestyle intervention for weight loss would decrease cardiovascular morbidity and mortality among such patients. METHODS: In 16 study centers in the United States, we randomly assigned 5145 overweight or obese patients with type 2 diabetes to participate in an intensive lifestyle intervention that promoted weight loss through decreased caloric intake and increased physical activity (intervention group) or to receive diabetes support and education (control group). The primary outcome was a composite of death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for angina during a maximum follow-up of 13.5 years. RESULTS: The trial was stopped early on the basis of a futility analysis when the median follow-up was 9.6 years. Weight loss was greater in the intervention group than in the control group throughout the study (8.6% vs. 0.7% at 1 year; 6.0% vs. 3.5% at study end). The intensive lifestyle intervention also produced greater reductions in glycated hemoglobin and greater initial improvements in fitness and all cardiovascular risk factors, except for low-density-lipoprotein cholesterol levels. The primary outcome occurred in 403 patients in the intervention group and in 418 in the control group (1.83 and 1.92 events per 100 person-years, respectively; hazard ratio in the intervention group, 0.95; 95% confidence interval, 0.83 to 1.09; P = 0.51). CONCLUSIONS: An intensive lifestyle intervention focusing on weight loss did not reduce the rate of cardiovascular events in overweight or obese adults with type 2 diabetes. (Funded by the National Institutes of Health and others; Look AHEAD ClinicalTrials.gov number, NCT00017953.)

AB - BACKGROUND: Weight loss is recommended for overweight or obese patients with type 2 diabetes on the basis of short-term studies, but long-term effects on cardiovascular disease remain unknown. We examined whether an intensive lifestyle intervention for weight loss would decrease cardiovascular morbidity and mortality among such patients. METHODS: In 16 study centers in the United States, we randomly assigned 5145 overweight or obese patients with type 2 diabetes to participate in an intensive lifestyle intervention that promoted weight loss through decreased caloric intake and increased physical activity (intervention group) or to receive diabetes support and education (control group). The primary outcome was a composite of death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for angina during a maximum follow-up of 13.5 years. RESULTS: The trial was stopped early on the basis of a futility analysis when the median follow-up was 9.6 years. Weight loss was greater in the intervention group than in the control group throughout the study (8.6% vs. 0.7% at 1 year; 6.0% vs. 3.5% at study end). The intensive lifestyle intervention also produced greater reductions in glycated hemoglobin and greater initial improvements in fitness and all cardiovascular risk factors, except for low-density-lipoprotein cholesterol levels. The primary outcome occurred in 403 patients in the intervention group and in 418 in the control group (1.83 and 1.92 events per 100 person-years, respectively; hazard ratio in the intervention group, 0.95; 95% confidence interval, 0.83 to 1.09; P = 0.51). CONCLUSIONS: An intensive lifestyle intervention focusing on weight loss did not reduce the rate of cardiovascular events in overweight or obese adults with type 2 diabetes. (Funded by the National Institutes of Health and others; Look AHEAD ClinicalTrials.gov number, NCT00017953.)

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