Intensive Lifestyle Intervention Research Articles

Intensive Weight-Loss Lifestyle Intervention Using Mediterranean Diet and COVID-19 Risk in Older Adults: Secondary Analysis of PREDIMED-Plus Trial

ObjectivesWe tested the effects of a weight-loss intervention encouraging energy-reduced MedDiet and physical activity (PA) in comparison to ad libitum MedDiet on COVID-19 incidence in older adults. DesignSecondary analysis of PREDIMED-Plus, a prospective, ongoing, multicentre randomized controlled trial. SettingCommunity-dwelling, free-living participants in PREDIMED-Plus trial. Participants6,874 Spanish older adults (55–75 years, 49% women) with overweight/obesity and metabolic syndrome. InterventionParticipants were randomised to Intervention (IG) or Control (CG) Group. IG received intensive behavioural intervention for weight loss with an energy-reduced MedDiet intervention and PA promotion. CG was encouraged to consume ad libitum MedDiet without PA recommendations. MeasurementsCOVID-19 was ascertained by an independent Event Committee until December 31, 2021. COX regression models compared the effect of PREDIMED-Plus interventions on COVID-19 risk. ResultsOverall, 653 COVID-19 incident cases were documented (IG:317; CG:336) over a median (IQR) follow-up of 5.8 (1.3) years (inclusive of 4.0 (1.2) years before community transmission of COVID-19) in both groups. A significantly lowered risk of COVID-19 incidence was not evident in IG, compared to CG (fully-adjusted HR (95% CI): 0.96 (0.81,1.12)). ConclusionsThere was no evidence to show that an intensive weight-loss intervention encouraging energy-reduced MedDiet and PA significantly lowered COVID-19 risk in older adults with overweight/ obesity and metabolic syndrome in comparison to ad libitum MedDiet. Recommendations to improve adherence to MedDiet provided with or without lifestyle modification suggestions for weight loss may have similar effects in protecting against COVID-19 risk in older adults with high cardiovascular risks.

Association of Lifestyle Intervention With Risk for Cardiovascular Events Differs by Level of Glycated Hemoglobin.

We reevaluated the Action for Health in Diabetes (Look AHEAD) intensive lifestyle intervention (ILI) to assess whether the effect of ILI on cardiovascular disease (CVD) prevention differed by baseline glycated hemoglobin (HbA1c). Look AHEAD randomized 5145 adults, aged 45 to 76 years with type 2 diabetes and overweight/obesity to ILI or a diabetes support and education (DSE) control group for a median of 9.6 years. ILI focused on achieving weight loss through decreased caloric intake and increased physical activity. We assessed the parent trial's primary composite CVD outcome. We evaluated additive and multiplicative heterogeneity of the intervention on CVD risk by baseline HbA1c. Mean baseline HbA1c was 7.3% (SD 1.2) and ranged from 4.4% (quintile 1) to 14.5% (quintile 5). We observed additive and multiplicative heterogeneity of the association between ILI and CVD (all P < .001) by baseline HbA1c. Randomization to ILI was associated with lower CVD risk for HbA1c quintiles 1 [hazard ratio (HR): 0.68, 95% confidence interval (CI): 0.53, 0.88] and 2 (HR: 0.80, 95% CI: 0.66, 0.96) and associated with higher CVD risk for HbA1c quintile 5 (HR: 1.27, 95% CI: 1.02, 1.58), compared to DSE. Among adults with type 2 diabetes and overweight/obesity, randomization to a lifestyle intervention was differentially associated with CVD risk by baseline HbA1c such that it was associated with lower risk at lower HbA1c levels and higher risk at higher HbA1c levels. There is a critical need to develop and tailor lifestyle interventions to be successful for individuals with type 2 diabetes and high HbA1c.

Abstract 15452: Using a Commercial Virtual Health Platform to Effectively Treat Obesity and Improve Cardiometabolic Risk Factors at Scale

Introduction: Obesity is a critical risk factor for cardiometabolic disease, yet effective treatment has not been available at scale for the &amp;gt;200 million Americans who meet criteria for obesity treatment. To improve access to evidence-based treatment, we established a virtual metabolic health company to provide medically supervised obesity treatment at scale. Research Questions: This real-world evaluation examines the impact of a virtual health program on weight and related cardiometabolic markers as well as self-reported assessment of key health behaviors in food, exercise, sleep, and emotional health. Methods: Data were analyzed for individuals who completed at least 12 months in the core program. Obesity treatment involved GLP-1 receptor agonist medications combined with a proprietary intensive lifestyle intervention delivered with virtual coaching. Weights were submitted via cellular connected scale. Waist circumference, metabolic labs, and patient questionnaires were also analyzed at baseline and 12 months. Results: The cohort includes 2,643 patients who completed at least 12 months. Average weight loss at 12, 15, and 18 months was 15.58% (n=2,397), 15.97% (n=1,319), and 15.82% (n=569). Improvement was observed for all collected metabolic markers: waist circumference, AST/ALT, lipids, HbA1c, insulin, hs-CRP. Specifically for cardiovascular labs, 12 month endpoints showed improvement in HDL in 51% (n= 1180), in LDL for 61% (n=1174), in hs-CRP for 81% (n=956). Of n=303 with abnormal A1c at baseline, 72.9% achieve A1c &amp;lt;5.7%. Average reduction in waist circumference was 5.95 inches (n=1,507). Positive changes were also seen for patient-reported outcomes. Discussion: Given limited access to effective obesity treatment as a pathway to better cardiometabolic disease management, novel approaches must be developed. Results from 2,643 enrollees in a virtual metabolic health program demonstrate clinically significant and sustained weight loss through 18 months, with improvement in associated key cardiometabolic risk markers, health behaviors, and patient-reported outcomes. This commercial program demonstrates promising results in cardiometabolic risk improvement through medically managed weight loss delivered virtually.

Preferences and Adherence of People with Prediabetes for Disease Management and Treatment: A Systematic Review.

To comprehensively summarize the evaluation, preference, and expectations of people with prediabetes regarding the management and treatment of pre-diabetes. Search PubMed, Embase, Web of Science, Cochrane Library and CNKI for articles about prediabetes, preferences, and expectations from inception of the database to June 2023. A total of 18 studies involving 17,240 participants with prediabetes were included. Although the preferences and views of people with prediabetes vary widely, there are certain trends: 1) Compared with drug therapy, people with prediabetes prefer exercise and nutrition therapies. 2) People with prediabetes expect intensive lifestyle interventions guided by professionals. 3) Effective communication between doctors and people with prediabetes is crucial for promoting the development and implementation of treatment plans. The results of this systematic review showed that people with prediabetes prefer intensive lifestyle interventions due to concerns about drug side effects, dependency, and other factors. In addition, drug acceptance and lifestyle interventions options differed among different populations, which emphasized the significance of individualized therapy.

A comparison of virtual and in person delivery of a full meal replacement program for obesity.

Full meal replacement (FMR) Intensive Lifestyle Interventions (ILI) have been used for weight management. However, predictors of efficacy with these programs are less clear. The primary objective was to assess weight loss predictors in a community-based FMR ILI program. A secondary objective was to determine if weight loss was different between virtual and in person ILI. This was a retrospective cohort study involving 234 patients who started the program between 1 January 2016 and 3 March 2021. In the 24-week program, patients spent 12weeks on FMR and then transitioned back to food for the remainder, with weekly follow up with a physician and group sessions with a dietitian. Visits were in person prior to March 2020 and virtual afterward. Patients' average age was 47.5years (SD=12.0) and 73.5% were female. Average weight loss was 14.3% (SD=6.2%). There was no significant difference in weight loss between virtual and in person programs. Patients on a Glucagon-like Peptide-1 Receptor Agonist prior lost less weight. Other significant associations between groups were baseline Hemoglobin A1C, classes attended, as well as the age since peak weight. Weight loss from virtual ILI was not significantly different from person ILI. More research is needed to determine how to best stratify care as virtual or in person using FMR programs.

Intensive Lifestyle Intervention for Remission of Early Type 2 Diabetes in Primary Care in Australia: DiRECT-Aus.

We aimed to assess whether remission of type 2 diabetes (T2D) could be achieved with a low-energy total diet replacement (TDR) in an Australian primary care setting. Individuals aged 20-65 years with T2D duration up to 6 years, BMI >27.0 kg/m2, and not treated with insulin were prescribed a 13-week low-energy TDR (Optifast; Nestlé Health Science) followed by 8-week structured food reintroduction and 31-week supported weight maintenance. The primary outcome was T2D remission at 12 months. A total of 155 participants comprised the intention-to-treat population. At 12 months, T2D remission was achieved in 86 (56%) participants, with a mean adjusted weight loss of 8.1% (95% CI 7.2-9.1). Two serious adverse events requiring hospitalization related to the study intervention were reported. At 12 months T2D remission was achieved for one in two Australian adults in a primary care setting.

Tirzepatide after intensive lifestyle intervention in adults with overweight or obesity: the SURMOUNT-3 phase 3 trial

The effects of tirzepatide, a glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonist, on weight reduction after successful intensive lifestyle intervention are unknown. This double-blind, placebo-controlled trial randomized (1:1) adults with body mass index ≥30 or ≥27 kg/m2 and at least one obesity-related complication (excluding diabetes), who achieved ≥5.0% weight reduction after a 12-week intensive lifestyle intervention, to tirzepatide maximum tolerated dose (10 or 15 mg) or placebo once weekly for 72 weeks (n = 579). The treatment regimen estimand assessed effects regardless of treatment adherence in the intention-to-treat population. The coprimary endpoint of additional mean per cent weight change from randomization to week 72 was met with changes of −18.4% (standard error (s.e.) 0.7) with tirzepatide and 2.5% (s.e. 1.0) with placebo (estimated treatment difference −20.8 percentage points (95% confidence interval (CI) −23.2%, −18.5%; P < 0.001). The coprimary endpoint of the percentage of participants achieving additional weight reduction ≥5% was met with 87.5% (s.e. 2.2) with tirzepatide and 16.5% (s.e. 3.0) with placebo achieving this threshold (odds ratio 34.6%; 95% CI 19.2%, 62.6%; P < 0.001). The most common adverse events with tirzepatide were gastrointestinal, with most being mild to moderate in severity. Tirzepatide provided substantial additional reduction in body weight in participants who had achieved ≥5.0% weight reduction with intensive lifestyle intervention. ClinicalTrials.gov registration: NCT04657016.

Testing the Effects of App-Based Motivational Messages on Physical Activity and Resting Heart Rate Through Smartphone App Compliance in Patients With Vulnerable Coronary Artery Plaques: Protocol for a Microrandomized Trial.

Achieving the weekly physical activity recommendations of at least 150-300 minutes of moderate-intensity or 75-150 minutes of vigorous-intensity aerobic exercise is important for reducing cardiometabolic risk, but evidence shows that most people struggle to meet these goals, particularly in the mid to long term. The Messages Improving Resting Heart Health (MIRTH) study aims to determine if (1) sending daily motivational messages through a research app is effective in improving motivation and in promoting adherence to physical activity recommendations in men and women with coronary heart disease randomized to a 12-month intensive lifestyle intervention, and (2) the time of the day when the message is delivered impacts compliance with exercise training. We will conduct a single-center, microrandomized trial. Participants will be randomized daily to either receive or not receive motivational messages over two 90-day periods at the beginning (phase 1: months 4-6) and at the end (phase 2: months 10-12) of the Lifestyle Vulnerable Plaque Study. Wrist-worn devices (Fitbit Inspire 2) and Bluetooth pairing with smartphones will be used to passively collect data for proximal (ie, physical activity duration, steps walked, and heart rate within 180 minutes of receiving messages) and distal (ie, change values for resting heart rate and total steps walked within and across both phases 1 and 2 of the trial) outcomes. Participants will be recruited from a large academic cardiology office practice (Central Sydney Cardiology) and the Royal Prince Alfred Hospital Departments of Cardiology and Radiology. All clinical investigations will be undertaken at the Charles Perkins Centre Royal Prince Alfred clinic. Individuals aged 18-80 years (n=58) with stable coronary heart disease who have low attenuation plaques based on a coronary computed tomography angiography within the past 3 months and have been randomized to an intensive lifestyle intervention program will be included in MIRTH. The Lifestyle Vulnerable Plaque Study was funded in 2020 and started enrolling participants in February 2022. Recruitment for MIRTH commenced in November 2022. As of September 2023, 2 participants were enrolled in the MIRTH study and provided baseline data. This MIRTH microrandomized trial will represent the single most detailed and integrated analysis of the effects of a comprehensive lifestyle intervention delivered through a customized mobile health app on smart devices on time-based motivational messaging for patients with coronary heart disease. This study will also help inform future studies optimizing for just-in-time adaptive interventions. Australian New Zealand Clinical Trials Registry ACTRN12622000731796; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382861. DERR1-10.2196/46082.

The national health service England diabetes prevention program—A narrative review

Abstract The National Health Service (NHS) Diabetes Prevention Program (DPP) is a comprehensive initiative in the United Kingdom aimed at preventing type 2 diabetes (T2DM) among individuals with prediabetes. The NHS DPP emphasizes early intervention and underscores the potential for preventing or delaying T2DM. Currently, it operates since 2015 at 44 geographically defined sites, serving an estimated annual volume of 200,000 patients. This narrative review evaluates the NHS DPP. A literature search, adhering to the Participants, Concept, and Context review framework, was conducted in various databases and sources, limited to the period from 2015 to 2023. Data were categorized based on publication date, study type, program indicators, and focus areas, forming the framework for the review discussion. The review search yielded a total of 18,357 articles, of which 45 were included, with a predominant focus on program effectiveness. The NHS DPP demonstrates strengths in risk reduction and cost-effectiveness but faces challenges related to fidelity and the needs of diverse populations. The review highlights the importance of evidence-based service delivery, stakeholder engagement, and digital innovation in future DPP programs. While a centralized approach provides structure, local flexibility is essential to cater to population-specific needs. This review underscores the importance of strategic planning, political support, partnerships, and robust data collection in DPP implementation. It recommends targeting high-risk individuals, intensive lifestyle interventions, and embracing digital solutions for program delivery. Ongoing research, including analysis of long-term data and user perspectives, will further enhance the evidence base for DPP programs worldwide.

Rationale, design, and cohort characteristics of the Action for Health in Diabetes Aging study.

Diabetes and overweight/obesity are described as accelerating aging processes, yet many individuals with these conditions maintain high levels of cognitive and physical function and independence late into life. The Look AHEAD Aging study is designed to identify 20-year trajectories of behaviors, risk factors, and medical history associated with resilience against geriatric syndromes and aging-related cognitive and physical functional deficits among individuals with these conditions. Look AHEAD Aging extends follow-up of the cohort of the former 10-year Look AHEAD trial. The original cohort (N = 5145) was enrolled in 2001 to 2004 when participants were aged 45 to 76 years and randomly assigned to a multidomain intensive lifestyle intervention (ILI) or a diabetes support and education (DSE) condition. The trial interventions ceased in 2012. Clinic-based follow-up continued through 2020. In 2021, the cohort was invited to enroll in Look AHEAD Aging, an additional 4-year telephone-based follow-up (every 6 months) enhanced with Medicare linkage. Standardized protocols assess multimorbidity, physical and cognitive function, health care utilization, and health-related quality of life. Of the original N = 5145 Look AHEAD participants, N = 1552 active survivors agreed to participate in Look AHEAD Aging. At consent, the cohort's mean age was 76 (range 63 to 94) years and participants had been followed for a mean of 20 years. Of the original Look AHEAD enrollees, those who were younger, female, or with no history of cardiovascular disease were more likely to be represented in the Look AHEAD Aging cohort. Intervention groups were comparable with respect to age, diabetes duration, body mass index, insulin use, hypertension, cardiovascular disease, and cognitive function. ILI participants had significantly lower deficit accumulation index scores. By continuing the long-term follow-up of an extensively characterized cohort of older individuals with type 2 diabetes, Look AHEAD Aging is well positioned to identify factors associated with resilience against aging-related conditions.

Association of Intensive Lifestyle Intervention for Type 2 Diabetes With Labor Market Outcomes

An intensive lifestyle intervention (ILI) has been shown to improve diabetes management and physical function. These benefits could lead to better labor market outcomes, but this has not been previously studied. To estimate the association of an ILI for weight loss in type 2 diabetes with employment, earnings, and disability benefit receipt during and after the intervention. This cohort study included participants with type 2 diabetes and overweight or obesity and compared an ILI with a control condition of diabetes support and education. Data for the original trial were accrued from August 22, 2001, to September 14, 2012. Trial data were linked with Social Security Administration records to investigate whether, relative to the control group, the ILI was associated with improvements in labor market outcomes during and after the intervention period. Difference-in-differences models estimating relative changes in employment, earnings, and disability benefit receipt between the ILI and control groups were used, accounting for prerandomization differences in outcomes for linked participants. Outcome data were analyzed from July 13, 2020, to May 17, 2023. The ILI consisted of sessions with lifestyle counselors, dieticians, exercise specialists, and behavioral therapists on a weekly basis in the first 6 months, decreasing to a monthly basis by the fourth year, designed to achieve and maintain at least 7% weight loss. The control group received group-based diabetes education sessions 3 times annually during the first 4 years, with 1 annual session thereafter. Employment and receipt of federal disability benefits (Supplemental Security Income and Social Security Disability Insurance), earnings, and disability benefit payments from 1994 through 2018. A total of 3091 trial participants were linked with Social Security Administration data (60.1% of 5145 participants initially randomized and 97.0% of 3188 of participants consenting to linkage). Among the 3091 with fully linked data, 1836 (59.4%) were women, and mean (SD) age was 58.4 (6.5) years. Baseline clinical and demographic characteristics were similar between linked participants in the ILI and control groups. Employment increased by 2.9 (95% CI, 0.3-5.5) percentage points for the ILI group relative to controls (P = .03) with no significant relative change in disability benefit receipt (-0.9 [95% CI, -2.1 to 0.3] percentage points; P = .13). The findings of this cohort study suggest that an ILI to prevent the progression and complications of type 2 diabetes was associated with higher levels of employment. Labor market productivity should be considered when evaluating interventions to manage chronic diseases.

Dietary intake during a pragmatic cluster-randomized weight loss trial in an underserved population in primary care

BackgroundCurrently there are limited data as to whether dietary intake can be improved during pragmatic weight loss interventions in primary care in underserved individuals.MethodsPatients with obesity were recruited into the PROPEL trial, which randomized 18 clinics to either an intensive lifestyle intervention (ILI) or usual care (UC). At baseline and months 6, 12, and 24, fruit and vegetable (F/V) intake and fat intake was determined. Outcomes were analyzed by repeated-measures linear mixed-effects multilevel models and regression models, which included random cluster (clinic) effects. Secondary analyses examined the effects of race, sex, age, and food security status.ResultsA total of 803 patients were recruited. 84.4% were female, 67.2% African American, 26.1% received Medicaid, and 65.5% made less than $40,000. No differences in F/V intake were seen between the ILI and UC groups at months 6, 12, or 24. The ILI group reduced percent fat at months 6, 12, and 24 compared to UC. Change in F/V intake was negatively correlated with weight change at month 6 whereas change in fat intake was positively associated with weight change at months 6, 12, and 24 for the ILI group.ConclusionsThe pragmatic weight loss intervention in primary care did not increase F/V intake but did reduce fat intake in an underserved population with obesity. F/V intake was negatively associated with weight loss at month 6 whereas percent fat was positively correlated with weight loss throughout the intervention. Future efforts better targeting both increasing F/V intake and reducing fat intake may promote greater weight loss in similar populations.Trial registrationNCT Registration: NCT02561221

A Narrative Review: Phentermine and Topiramate for the Treatment of Pediatric Obesity.

The prevalence of pediatric obesity has increased exponentially over the past four decades. The American Academy of Pediatrics recently released updated clinical practice guidelines highlighting the importance of identifying pediatric obesity as a chronic disease. The guidelines support consideration of concurrent treatment with intensive lifestyle interventions, obesity pharmacotherapy, and bariatric surgery. The dramatic rise in pediatric obesity has spurred interest in utilizing obesity pharmacotherapy to support sustained weight reduction in pediatric cohorts, in the hopes of preventing the emergence of later-appearing, significant co-morbidities. Despite the enormous demand, the obstacles posed by performance of needed clinical trials in the pediatric population markedly limits available pharmacotherapy for the treatment of obesity in pediatrics. Currently, there are five medications approved by the Food and Drug Administration for use in youth with obesity. In 2022, the phentermine/topiramate (PHEN/TPM), once-daily, controlled-release, combination product received FDA approval, for the indication of chronic weight management, in youth with obesity, ages 12 years and older. The objectives of this narrative review are to: (1) Review the mechanism of action of phentermine and topiramate, (2) Summarize the safety and efficacy data of topiramate and phentermine use as both monotherapies and in combination, and (3) Discuss clinical practice guidelines and clinical implications, for the use of these agents in youths with obesity.

Effects of metformin and intensive lifestyle interventions on the incidence of kidney disease in adults in the DPP/DPPOS

AimsWe analyzed the incidence of kidney disease in the Diabetes Prevention Program Outcomes Study (DPPOS) by originally randomized treatment group assignment: Intensive Lifestyle (ILS), Metformin (MET) or Placebo (PLB). MethodsThe current analyses used a time-to-event approach in which the primary outcome was kidney disease, ascertained as urine albumin-to-creatinine ratio (ACR) ≥ 3.39 mg/mmol (30 mg/g) or eGFR <45 mL/min/1.73m2, with confirmation required at the next visit, or adjudicated end-stage kidney disease (ESKD). ResultsAt a median of 21 years following randomization in DPP, diabetes development was reduced in both the ILS (HR 0.73 [95%CI = 0.62, 0.85]) and MET groups (HR 0.85 [0.73, 0.99]) compared to the PLB group. Although risk for developing the primary kidney disease outcome was higher among those with incident diabetes compared to those without (HR 1.81 [1.43, 2.30]), it did not differ by intervention groups (ILS vs. PLB 1.02 (0.81, 1.29); MET vs. PLB 1.08 (0.86, 1.35). There was a non-significant metformin by age interaction (p = 0.057), with metformin being beneficial for kidney disease in the younger but potentially harmful in the older participants. ConclusionsDevelopment of kidney disease was increased in participants who developed diabetes but did not differ by original treatment group assignment. Clinical trial registrationsDiabetes Prevention Program (DPP) Clinical trial reg. no. NCT00004992DPP Outcomes Study (DPPOS) Clinical trial reg. no. NCT0038727

Strategies to improve the implementation of intensive lifestyle interventions for obesity.

Strategies to improve the implementation of intensive lifestyle interventions for obesity.

The long-term effect of intentional weight loss on changes in bone mineral density in persons with type 2 diabetes: results from the Look AHEAD randomized trial

SummaryIntentional weight loss has been shown to increase bone loss short term but the long-term effects are not known. Data from the Look AHEAD clinical trial shows that a long term intentional weight loss intervention was associated with greater bone loss at the hip in men.PurposeIntentional weight loss has been shown to increase bone loss short term and increase frailty fracture risk, but the long-term effects on bone mineral density (BMD) are not known.MethodsData from a subgroup from the Look AHEAD (LA) multicenter, randomized clinical trial was used to evaluate whether a long term intentional weight loss intervention would increase bone loss. In a preplanned substudy, BMD was assessed at 5 of the 16 LA clinical centers using dual-energy X-ray absorptiometry at baseline, year 8, and the observational visit 12.6–16.3 years after randomization (year 12–16).ResultsAt year 8, bone density loss (%) was greater in the Intensive Lifestyle Intervention (ILI) group compared with the control group (DSE) for the femoral neck (p = 0.0122) but this finding was not observed at the year 12–16 visit. In analyses stratified by gender, bone density loss (%) was greater at the total hip for men in the ILI group than the DSE group at both the year 8 and year 12–16 visits (year 8 p = 0.0263 and year 12–16 p = 0.0062). This finding was not observed among women.ConclusionLong term intentional weight loss was associated with greater bone loss at the hip in men. These results taken with the previously published Look AHEAD data from the entire clinical trial showing increased frailty fracture risk with weight loss in the ILI group suggest that when intentional weight loss is planned, consideration of bone density preservation and fracture prevention strategies is warranted.Trial RegistrationClinicaltrials.gov Identifier: NCT00017953. June 21, 2001

Management of Type 2 Diabetes in Frail Older Adults.

Aging is one of the most important factors associated with the dramatic increase in the prevalence of type 2 diabetes mellitus (T2DM) globally. In addition to traditional micro- and macrovascular complications, diabetes mellitus (DM) in older adults is of great importance due to its independent relationship with frailty, which is defined as a decline in functional reserves and vulnerability to stressors. Frailty assessment enables the determination of biological age, thus predicting potential complications in older adults and identifying tailored treatment strategies. Although the latest guidelines have acknowledged the frailty concept and provided recommendations specific to this subgroup of older adults, frail older adults are particularly considered only as anorexic, malnourished people for whom relaxed treatment targets should be set. However, this approach bypasses other metabolic phenotypes in the context of diabetes and frailty. Recently, a spectrum of metabolic phenotypes in the context of frailty in DM was suggested, and the two edges of this spectrum were defined as "anorexic malnourished (AM)" and "sarcopenic obese (SO)." These two edges were suggested to require different strategies: Opposite to the AM phenotype requiring less stringent targets and de-intensification of treatments, tight blood glucose control with agents promoting weight loss was recommended in the SO group. Our suggestion is that, regardless of their phenotype, weight loss should not be the primary goal in DM management in older adults who are overweight or obese, because of the increased malnutrition prevalence in older adults suffering from DM compared with standard older adults. Furthermore, overweight older adults have been reported to have the lowest risk of mortality compared with other groups. On the other hand, obese older individuals may benefit from intensive lifestyle interventions including caloric restriction and regular exercise with the assurance of at least 1 g/kg/day high-quality protein intake. Besides metformin (MF), sodium-glucose cotransporter-2 inhibitors (SGLT-2i) or glucagon-like peptide-1 receptor agonists (GLP-1RA) should be considered in appropriate SO cases, due to high evidence of cardiorenal benefits. MF should be avoided in the AM phenotype due to their weight loss property. Although weight loss is not desired in AM phenotype, SGLT-2i may still be preferred with close follow-up in certain individuals demonstrating high cardiovascular disease (CVD) risk. Of note, SGLT-2i should be considered earlier in the diabetes treatment in both groups due to their multiple benefits, i.e., organ protective effects, the potential to reduce polypharmacy, and improve frailty status. The concept of different metabolic phenotypes in frail older adults with diabetes once again shows "one size fits all" cannot be applied in geriatric medicine, and a tailored, individualized approach should be adopted to get the highest benefit from treatments.

Physical Activity as a Lifestyle Modification in Patients With Multiple Comorbidities: Emphasizing More on Obese, Prediabetic, and Type 2 Diabetes Mellitus Patients.

In this research, physical activity (PA) was shown to be inversely associated with the incidence of diabetes. This emphasizes the relevance of PA in diabetes prevention lifestyle intervention initiatives and encourages healthcare practitioners to advise high-risk patients on a healthy lifestyle combining PA for the reduction of weight in prediabetic, obese, and type 2 diabetes mellitus (T2DM) patients. The link between PA and diabetes was stronger in people with moderate or higher baseline PA, reflecting national recommendations that imply increasing activity levels may provide larger advantages for those who are comparatively less active. An intensive lifestyle intervention of eating healthier foods and increasing PA resulted in an effective decrease in weight and waist circumference after one year, which has high potential in the long term to prevent T2DM and different comorbidities such as obesity. Studies such as PRomotion Of Physical activity through structured Education with differing Levels of ongoing Support for those with prediabetes (PROPELS) demonstrate that the combination of PA interventions with telemedicine follow-ups results in ambulatory activity changes in the first year, but these changes do not last longer than four years. Acute PA practicing regularly will reduce postprandial glucose excursions. However, it is unknown what type of PA routine will benefit the most from reducing postprandial glucose levels. There are no discernible variations in the effects of different disciplines of training on glucose levels, mainly when the data are compared across time. The combination of a healthy diet and lifestyle with programs based on diabetes prevention results in comparable and clinically significant mean weight reduction with cardiometabolic advantages. Based on the reviewed and cited studies, PA in patients at high risk of T2DM and obese and non-obese patientswith T2DM results infavorable outcomes in the first few months. There is a large gap in investigations of the effects of PA in these patients and the benefits of other lifestyle modifications in long-term-based studies. However, in this study, we emphasize the importance of lifestyle modifications, putting in perspective principally the PA that the majority of patients with comorbidities do not practice, especially those with obesity, prediabetes, and T2DM. Thus, it would be necessary to conduct long-interval studies such as randomized clinical trials, where a better outcome can be given about intervals based on daily exercise times and the type of exercise in conjunction with diets that will have the greatest benefit, focusing more on the subjects that our research mentioned.

1714-P: Higher Initial Diet Quality Predicts Shorter Weight Loss Period prior to an Involuntary Weight Loss Plateau

It is currently unknown what factor(s) may promote entry into a weight loss plateau. Given intensive lifestyle interventions (ILI) for weight loss include changes in diet, we evaluated how diet quality impacts characteristics of a weight loss plateau. Daily weights were obtained remotely via electronic scale from 62 adults with obesity (73% female, mean age 42±11 y and BMI 37±5 kg/m2) undergoing a 24-week ILI. Periods (≥14 d) of active weight loss or plateau were identified by threshold regression modeling. Active weight loss was defined as a per day % weight change from baseline equivalent to ≥0.5 lb loss/wk and a weight loss plateau as ±0.25lbs/wk after a period of active weight loss (in which ≥3.5% weight loss was achieved). Three unannounced self-reported ASA24 dietary recalls were obtained at baseline and 3 mo. Diet quality was assessed by the healthy eating index (HEI)-2015. 53% reached a plateau after active weight loss (27% did not achieve &amp;gt;3.5% weight loss, 19% re-gained directly after loss). Weight loss (i.e., plateau depth) was associated with longer time to plateau (β=–10d, P&amp;lt;0.01). Higher baseline diet quality (total HEI) was associated with shorter time to plateau (β=–2.6d, P=0.03), but not overall depth of plateau (β=0.1%, P=0.28). Specifically, shorter time to plateau was related to lower baseline consumption of saturated fats (β=–15d, P=0.01) and greater plateau depth was related to lower baseline consumption of added sugars (β=1.3%, P=0.04). Mean diet quality improved minimally during ILI (ΔHEI 1.9±2.2). Lower baseline HEI correlated with greater improvement in diet quality at 3 mo (β=–0.5, P&amp;lt;0.001, N=46), but ΔHEI did not associate with any plateau characteristics (time: β=1.1d, P=0.15; depth: β=–0.1%, P=0.16, N=25). Higher diet quality upon entry into an ILI predicted a shorter duration of weight loss prior to reaching a plateau, suggesting that individuals with healthy eating patterns may derive less sustained weight loss benefit from participation in an ILI. Disclosure S.J.Melhorn: None. L.E.Sewaybricker: None. H.Gao: None. M.De leon: None. M.Webb: None. M.Lyle: None. S.J.Beatty: None. M.Kratz: Other Relationship; Nourished by Science LLC. E.Schur: None. Funding National Institutes of Health (DK089036, DK1176223, K24HL144917); University of Washington (NORC, DK035816)

441-P: Long-Term Effects of Intensive Lifestyle Intervention in Real-World Clinical Practice on Cardiometabolic Outcomes in Patients with Diabetes—A 15-Year Longitudinal Study

We previously demonstrated that achieving and maintaining ≥7% weight loss at one year in patients with diabetes (DM), through multidisciplinary intensive lifestyle intervention (ILI) in real-world clinical practice, predicts improvement in cardiometabolic outcomes at 5 and 10 years. In this prospective follow-up, we report 15-year results. We evaluated 122 patients with DM and obesity (mean age 53.2±10.0 years, 68% females, 90.2% type 2, mean DM duration 9.1±8.6 years, mean BMI 38.4±5.2 kg/m²) who underwent 12 weeks of ILI. The total cohort lost in average 10.7±4.6 kg (-9.6%, p&amp;lt;0.001) after 12 weeks. At 1 year, they were divided into group A, who maintained &amp;lt;7% weight loss (47.5%), and group B, who maintained ≥7% weight loss (52.5%). At 15 years, average weight loss in the entire cohort was 8.6±11.9 Kg (-7.6%, p&amp;lt;0.001). Group A maintained an average weight loss of 3.9±6.5 kg (-3.6%) at 5 years, 3.8±9.4 kg (-3.9%) at 10 years and 3.8±10.0 kg (-4.0%) at 15 years. Group B maintained an average weight loss of 10.6±9.8 kg (-9.1%) at 5 years, 10.8±9.6 kg (-9.3%) at 10 years and 12.9±12.0 Kg (-11.0%) at 15 years. At 15 years, weight loss in group B remained significantly higher than in group A (p&amp;lt;0.001). In group A, A1C reduced from 7.5±1.4% to 6.7±0.9% at 12 weeks, but rebounded to 8.0±1.9% at 5 years and 10 years and was 7.9±1.8% at 15 years. In group B, A1C decreased from 7.3±1.1% to 6.3±0.8% at 12 weeks, and was 7.4±1.6% at 5 years, 7.2±1.4% at 10 years and 7.3±1.5% at 15 years (p=0.04 between groups). Both groups maintained significant improvements in LDL- and HDL-cholesterol at 15 years, but group A had significant worsening of their serum triglycerides. Both groups had nonsignificant changes in blood pressure at 15 years. In conclusion, ILI in real-world clinical practice that results in ≥7% weight loss at one year in patients with DM and obesity is associated with continued improvement in cardiometabolic outcomes at 15 years. Disclosure A.Khater: None. M.Al-badri: None. T.Salah: None. S.E.Dhaver: None. K.Kibaa: None. R.Mccarragher: None. O.Hamdy: Advisory Panel; Abbott Nutrition, Nemaura Medical, L-Nutra Inc., Twin Health, Consultant; Sanofi, Research Support; Novo Nordisk, Eli Lilly and Company, Gilead Sciences, Inc., Stock/Shareholder; Healthimation.