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The Look AHEAD Trial: A Review and Discussion of Its Outcomes

  • Public Health and Translational Medicine (PW Franks, Section Editor)
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Abstract

The Look AHEAD trial was a randomized controlled trial comparing an intensive lifestyle intervention (ILI) to diabetes support and education (DSE) in overweight and obese type 2 diabetes patients to track the development of cardiovascular disease over time. The triaI intervention was stopped for futility after a median follow-up of 9.6 years. While there was a differential effect on weight loss and fitness between the two groups, there was no effect on cardiovascular outcomes. Cardiovascular events were less than half the projected rate per year in the DSE group, thus there was a very low overall rate of events in both groups. There were many other health benefits of ILI, including improved biomarkers of glucose and lipid control, less sleep apnea, lower liver fat, less depression, improved insulin sensitivity, less urinary incontinence, less kidney disease, reduced need of diabetes medications, maintenance of physical mobility, improved quality of life, and lower costs.

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References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. International Diabetes Federation. IDF Diabetes Atlas. 6th ed. Brussels: International Diabetes Federation; 2013. http://www.idf.org/diabetesatlas.

    Google Scholar 

  2. Flegal KM, Carroll MD, Kit BK, Ogden CL. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999-2010. JAMA. 2012;307:491–7.

    Article  PubMed  Google Scholar 

  3. Guh DP, Zhang W, Bansback N, et al. The incidence of co-morbidities related to obesity and overweight: a systematic review and meta-analysis. BMC Public Health. 2009;9:88. doi:10.1186/1471-2458-9-88.

    Article  PubMed Central  PubMed  Google Scholar 

  4. Fact sheet: Obesity and overweight [internet], Geneva, Switzerland: World Health Organization (international). [Updated 2013 March; cited 2014] Available from: http://www.who.int/mediacentre/factsheets/fs311/en/index.html.

  5. Emerging Risk Factor Collaboration. Diabetes fasting glucose concentration and risk of vascular disease: a collaborative metaanalysis of 102 prospective studies. Lancet. 2010;375:2215–22.

    Article  Google Scholar 

  6. NIH press release Oct 19,2012.

  7. The Look AHEAD Research Group. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. NEJM. 2013;369:145–54. This is the final results paper with the weight, fitness, and cardiovascular outcomes.

    Article  PubMed Central  Google Scholar 

  8. Espeland MA, Glick HA, Bertoni A, for the Look AHEAD Research Group, et al. Impact of an intensive lifestyle intervention on use and cost of medical services amont overweight and obese adults with type 2 diabetes: the Actsion for Health in Diabetes. Diabetes Care. 2014;37:2548–56.

    Article  PubMed  Google Scholar 

  9. 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. Con Clin Trials. 2003;24:610–28. This explains the design of the study.

    Article  Google Scholar 

  10. Look AHEAD Research Group, Bray G, Gregg E, Haffner S, et al. Baseline characteristics of the randomized cohort from the Look AHEAD (action for Health in Diabetes) study. Diab Vasc Dis Res. 2006;3:202–15.

    Article  PubMed  Google Scholar 

  11. Wadden TA, Smith West D, Delahanty LM, Jakicic JM, Rejeski J, Berkowitz KL, et al. The Look AHEAD study: a description of the lifestyle intervention and the evidence supporting it. Obesity. 2006;14(5):737–52. This gives a description of the intensive intervention in the trial.

    Article  PubMed  Google Scholar 

  12. The Look AHEAD Research Group, Pi-Sunyer, et al. Reduction in weight and cardiovascular disease risk factors in individuals with type 2 diabetes: one-year results of the Look AHEAD trial. Diabetes Care. 2007;30:1374–83.

    Article  PubMed  Google Scholar 

  13. Jakicic JM, Jaramillo SA, Balasubramanyam A, et al. Effect of a lifestyle intervention on change in cardiorespiratory fitness in adults with type 2 diabetes: results from the Look AHEAD study. Int J Obes (Lond). 2009;33:305–16.

    Article  CAS  Google Scholar 

  14. Ribisl P, Gaussoin SA, Lang W, et al. Lifestyle intervention improves heart rate recovery from exercise in adults with type 2 diabetes: results from the Look AHEAD Study. J Obes 2012: Article ID 309196.

  15. 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 Int Med. 2010;170:1566–75.

    Google Scholar 

  16. The Look AHEAD Research Group. Eight-year weight losses with an intensive lifestyle intervention: the Look AHEAD Study. Obesity. 2014;22:5–13.

    Article  PubMed Central  Google Scholar 

  17. Foster GD, Borradaile KE, Sanders MH, et al. A randomized study on the effect of weight loss on obstructive sleep apnea among obese patients with type 2 diabetes, the Sleep AHEAD study. Arch Int Med. 2009;169:1619–26.

    Article  Google Scholar 

  18. Kuna ST, Reboussin DM, Borradaile KE, Sanders MH, Millman RP, Zammit G, et al. Long-term effect of weight loss on obstructive sleep apnea severity in obese patients with type 2 diabetes. Sleep. 2013;36:641–9.

    PubMed Central  PubMed  Google Scholar 

  19. Lazo M, Solga S, Horska A, et al. Effect of a 12-month intensive lifestyle intervention on hepatic steatosisin adults with type 2 diabetes. Diab Care. 2010;33:2156–63.

    Article  Google Scholar 

  20. Faulconbridge L, Wadden T, Rubin R, et al. One-year changes in symptoms of depression and weight in overweight/obese individuals with type 2 diabetes in the Look AHEAD study. Obesity (Silver Spring). 2012;20:783–93.

    Article  PubMed Central  Google Scholar 

  21. The Look AHEAD Research Group. Impact of intensive lifestyle intervention on depression and health-related quality of life in type 2 diabetes: The Look AHEAD trial. Diabetes Care 2014;37:1544–1553.

  22. Phelan S, Kanaya A, SubakL, et al. Weight loss prevents urinary incontinence in women with type 2 diabetes: Results from the Look AHEAD Trial. J Urol. 2012;187:939–44.

    Article  PubMed Central  PubMed  Google Scholar 

  23. The Look AHEAD Research Group. Effect of a long-term behavioral weight loss intervention on nephropathy in overweigth or obese adults with type 2 diabetes: the Look AHEAD randomised clinical trial. Lancet Diabetes Endocrinol. 2014. doi:10.1016/S2213-8587(14)70156-1.

  24. Redmon B, Bertoni A, Connely S, et al. Effect of the Look AHEAD study intervention on medication use and related cost to treat cardiovascular disease risk factors in individuals with type 2 diabetes. Diabetes Care. 2010;33:1153–8.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  25. Jakicic JM, Egan CM, Fabricatore AN, Gaussoin SA, Glasser SP, Hesson LA, et al. Four-year change in cardiorespiratory fitness and influence on glycemic control in adults with type 2 diabetes in a randomized trial: the Look AHEAD Trial. Diab Care. 2013;36:1297–303.

    Article  CAS  Google Scholar 

  26. Williamson D, Rejeski J, Lang WA, et al. Impact of a weight management program on health-related quality of life in overweight adults with type 2 diabetes. Arch Int Med. 2009;169:163–71.

    Article  Google Scholar 

  27. Foy C, Lewis B, Hairston K, et al. Intensive lifestyle intervention improves physical function among obese adults with knee pain: Findings from the Look AHEAD Trial. Obesity (Silver Spring). 2011;19:83–93.

    Article  Google Scholar 

  28. Wing RR, Bond DS, Gendrano 3rd IN, et al. Effect of intensive lifestyle intervention on sexual dysfunction in women with type 2 diabetes: results from an ancillary Look AHEAD study. Diabetes Care. 2013;36:2937–44.

    Article  PubMed Central  PubMed  Google Scholar 

  29. Belalcazar M, Haffner S, Lang W, et al. Lifestyle intervention and/or statins for the reduction of C-reactive protein in diabetes: from the Look AHEAD Study. Obesity (Silver Spring). 2013;21:944–50.

    Article  CAS  Google Scholar 

  30. Brancati FL et al. Midcourse correction to a clinical trial when the event rate is underestimated.: the LookAHEAD (Action for Health in Diabetes) Study. Clin Trials. 2012;9:113–24.

    Article  PubMed Central  PubMed  Google Scholar 

  31. Diabetes Prevention Program Research Group. Reduction in the incidence of ype 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346:393–403.

    Article  PubMed Central  Google Scholar 

  32. Unick JL, Beavers D, Jakicic JM, Kitabchi AE, Knowler WC, Wadded TA, et al. Effectiveness of lifestyle interventions for individuals with severe obesity and type 2 diabetes: results from the Look AHEAD trial. Diabetes Care. 2011;34:2152–7.

    Article  PubMed Central  PubMed  Google Scholar 

  33. Look AHEAD Research Group, Wadden TA, West DS. The Look AHEAD study: a description of the lifestyle intervention and the evidence supporting it. Obesity (Silver Spring). 2006;14:737–52 [Erratum, Obesity (Silver Spring) 2007; 15: 1339.].

    Article  Google Scholar 

  34. Gregg EW, Chen H, Wagenknecht LE, et al. Association of an intensive lifestyle intervention with remission of type 2 diabetes. JAMA. 2012;308:2489–98.

    Article  CAS  PubMed  Google Scholar 

  35. Haffner SM, Stern MP, Hazuda HP, et al. Cardiovascular risk factors in confirmed prediabetic individuals. Does the clock for coronary heart disease start ticking before the onset of clinical diabetes? JAMA. 1990;263:2893–8.

    Article  CAS  PubMed  Google Scholar 

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Conflict of Interest

Xavier Pi-Sunyer declares that he has no conflict of interest.

Human and Animal Rights and Informed Consent

This article contains studies with human subjects performed by Look Ahead investigators.

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Authors and Affiliations

  1. Columbia University College of Physicians and Surgeons, P&S PO Box 30 DOM/NYORC, 630 West 168th Street, New York, NY, 10032, USA

    Xavier Pi-Sunyer

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  1. Xavier Pi-Sunyer
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Correspondence to Xavier Pi-Sunyer.

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Pi-Sunyer, X. The Look AHEAD Trial: A Review and Discussion of Its Outcomes. Curr Nutr Rep 3, 387–391 (2014). https://doi.org/10.1007/s13668-014-0099-x

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