Implementing a Digital-Enhanced Multiple-Behavior Self-Monitoring Intervention in Diabetes Care and Support: A Mixed-Method Evaluation of Patient Outcomes.

Weight Loss Prevents Urinary Incontinence in Women With Type 2 Diabetes: Results From the Look AHEAD Trial

Cardiovascular Protection in People With Diabetes.

Pharmacologic Glycemic Management of Type 2 Diabetes in Adults.

Look Action for Health in Diabetes trial: What we have learned in terms of real world practice and clinical trials.

The Diabetes Prevention Program (DPP) and the Action for Health in Diabetes (Look AHEAD) Study were important, large, randomized trials that evaluated the effects of a lifestyle intervention, including diet and physical activity, in persons at risk for or with type 2 diabetes. The DPP Study found that a lifestyle intervention targeting ≥7% weight loss and ≥150 min/week of physical activity effectively reduced diabetes incidence by 58% over an average of 2.8 years. Though weight loss was a stronger predictor of decreased diabetes incidence in DPP, achieving the targeted 150 min/week of physical activity predicted greater weight loss, was easier for participants to achieve (vs. the weight loss target), and decreased diabetes risk by 44% even when weight loss and dietary fat goals were not achieved. These findings strongly support physical activity for diabetes prevention. The Look AHEAD Study evaluated whether a lifestyle intervention targeting ≥7% weight loss and ≥175 min/week of physical activity could reduce major cardiovascular events in adults with preexisting diabetes. After an average 9.6 years of follow-up, the lifestyle intervention was not effective for reducing cardiovascular events as compared to the control group. Despite the failure to find a benefit on the primary outcome, increases in physical activity and, to a greater extent, cardiorespiratory fitness were independently related to more weight loss, better glycemic control, reduced cardiovascular risk factors, and increased health-related quality of life among Look AHEAD Study participants. Thus, physical activity that increases fitness remains an important part of treatment recommendations for adults with type 2 diabetes.

Commentary on: Wing RR, Bolin P, Brancati FL, et al. Look AHEAD Research Group. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N Engl J Med 2013;369:145–54.[OpenUrl][1][CrossRef][2][PubMed][3][Web of...

Fiber Intake and Plasminogen Activator Inhibitor-1 in Type 2 Diabetes: Look AHEAD (Action for Health in Diabetes) Trial Findings at Baseline and Year 1

The Association of Total Knee Arthroplasty With Weight Loss in the Look AHEAD (Action for Health in Diabetes) Clinical Trial

Short-term weight loss improves cardiovascular disease (CVD) risk factors. We sought to determine the longer-term effects of maintaining weight loss or, conversely, regaining weight. We used data from Action for Health in Diabetes (Look AHEAD), a randomized trial of intensive lifestyle intervention (ILI) compared to a control condition in overweight/obese individuals with type 2 diabetes. ILI participants were grouped according to weight change patterns, as follows: 1) no weight loss (±3% at years 1 and 4); 2) moderate weight loss (3-8% at years 1 and 4); 3) large weight loss (8-20% at years 1 and 4); 4) moderate loss/full regain (3-8% at year 1/±3% at year 4); 5) large loss/full regain (8-20% at year 1/± 3% year 4); and 6) large loss/partial regain (8-20% at year 1/3-8% at year 4) and changes in CVD risk factors were compared. Adjusting for baseline differences and medication use, larger weight losses produced greater improvements in HbA1c, systolic blood pressure, HDL cholesterol, and triglycerides at years 1 and 4 (all P ≤ 0.02). Despite maintenance of weight loss, HbA1c levels worsened between years 1 and 4, and remained below baseline only in those with large weight losses. We found no negative associations of losing and regaining weight relative to not having lost weight. Moreover, those who had large initial weight loss but full regain of weight had greater improvements in HbA1c levels at year 4 than those with smaller or no initial weight loss. Larger initial weight loss should be encouraged in individuals with type 2 diabetes, despite the possibility of regain.

ObjectiveTo evaluate 8-year weight losses achieved with intensive lifestyle intervention (ILI) in the Look AHEAD (Action for Health in Diabetes) study.Design and MethodsLook AHEAD assessed the effects of intentional weight loss on cardiovascular morbidity and mortality in 5,145 overweight/obese adults with type 2 diabetes, randomly assigned to ILI or usual care (i.e., diabetes support and education [DSE]). The ILI provided comprehensive behavioral weight loss counseling over 8 years; DSE participants received periodic group education only.ResultsAll participants had the opportunity to complete 8 years of intervention before Look AHEAD was halted in September 2012; ≥88% of both groups completed the 8-year outcomes assessment. ILI and DSE participants lost (mean±SE) 4.7±0.2% and 2.1±0.2% of initial weight, respectively (p<0.001) at year 8; 50.3% and 35.7%, respectively, lost ≥5% (p<0.001), and 26.9% and 17.2%, respectively, lost ≥10% (p<0.001). Across the 8 years ILI participants, compared with DSE, reported greater practice of several key weight-control behaviors. These behaviors also distinguished ILI participants who lost ≥10% and kept it off from those who lost but regained.ConclusionsLook AHEAD’s ILI produced clinically meaningful weight loss (≥5%) at year 8 in 50% of patients with type 2 diabetes and can be used to manage other obesity-related co-morbid conditions.Trial Registrationclinicaltrials.gov Identifier: NCT00017953

Sheila A Doggrell School of Biomedical Science, Faculty of Health, Queensland University of Technology, Brisbane, QLD, AustraliaA recent review by Salvo et al published in Patient Preference and Adherence concerned dapagliflozin, and was titled &amp;amp;ldquo;Patient considerations in the management of type 2 diabetes &amp;amp;ndash; critical appraisal of dapagliflozin&amp;amp;rdquo;.1 Having read the article, I do not consider it to be a critical appraisal of dapagliflozin. Thus, after comparing dapagliflozin with other oral antidiabetic medications, the authors concluded that &amp;amp;ldquo;Dapagliflozin&amp;amp;rsquo;s noted blood pressure reduction, weight loss, and low potential to cause hypoglycemia are advantageous, when compared with currently available oral medications&amp;amp;rdquo;.1 This statement is not supported by the content of the review and/or the literature.&amp;amp;nbsp;Read the original article&amp;amp;nbsp;

Comparison among criteria to define successful weight-loss maintainers and regainers in the Action for Health in Diabetes (Look AHEAD) and Diabetes Prevention Program trials

Association of the Intensive Lifestyle Intervention With Total Knee Replacement in the Look AHEAD (Action for Health in Diabetes) Clinical Trial

ook AHEAD (Action for Health in Diabetes), the largest cardiovascular disease (CVD) outcomes trial of an intensive lifestyle intervention for weight loss in diabetes mellitus, was stopped on September 14, 2012, on the basis of a futility analysis of its composite primary end point (death from cardiovascular causes, nonfatal myocardial infarction [MI], nonfatal stroke, or hospitalization for angina) and recommendations from the Data and Safety Monitoring Board. 1 Its results have been widely interpreted as evidence that weight loss with lifestyle intervention does not confer CVD benefits in patients with diabetes mellitus.In contrast, recent trials of pharmacological antihyperglycemic therapies, EMPA-REG Outcome with empagliflozin (BI 10773 [Empagliflozin] Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients), 2 LEADER (Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results) with liraglutide, 3 and SUSTAIN-6 (Trial to Evaluate Cardiovascular and Other Long-term Outcomes with Semaglutide in Subjects with Type 2 Diabetes) with semaglutide, 4 demonstrated both weight loss and reduced cardiovascular morbidity and mortality.Before concluding that lifestyle modification does not provide cardiovascular benefit in patients with diabetes mellitus, whereas drug therapy does, it is important to examine closely the end points, participants, and interventions in Look AHEAD in comparison with those in the pharmaceutical trials (Table ).

146-OR: Specific Metabolomic Signatures Associate with Diabetes Remission after Weight Loss