We all know the Henny Youngman line: “I don’t get no respect.” This line rings true regarding research on the effectiveness of healthy lifestyle changes (eg: behavior changes for healthy eating and physical activity) to prevent or treat diseases – among diseases impacted: prediabetes and type 2. Yet the impressive role of lifestyle changes (along with a hefty among of expert-led support) in preventing or delaying type 2 or slowing the progression of type 2 has and continues to be reinforced by research studies over and over again. These results, however, don’t seem to have the media sizzle to attract headlines like the studies of costly drug therapies (to name one, the famed diabetes ACCORD Trial). So the public continues to have their tax dollars spent on these lifestyle-fcoused studies without quickly hearing about their findings.
The message of the powerful role of minimal weight loss attained with healthy lifestyle changes (physical activity, intensive support and use of meal replacements) in type 2 was reiterated recently. This happened when the interim results (the 4 year mark) of the lengthy NIH multicenter study known as Look AHEAD – Action for Health in Diabetes, were published (Archives of Internal Medicine, Sept 27, 2010). (Year one results published in Diabetes Care: 2007;30:1374-83.)
Let’s look at the Look AHEAD details:
The study was initiated through the National Institutes of Health nearly 10 years ago and is currently scheduled to conclude in 2014 (it's already been extended once). Look AHEAD enrolled over five thousand people 55 to 74 years old with type 2 diabetes who were risk for heart and blood vessel diseases (as are most people with type 2). Enrollees had diabetes on average of 7 years with a range from 3 months to 13 years. People were studied at 16 centers around the U.S. One half of the participants received what’s called intensive lifestyle intervention (ILI) and the other half, the control group, received what’s called Diabetes Support and Education (DSE). DSE is intended to be minimal care (however, let's admit it, for many people this is more care than many people in actuality receive).
The reason this study is so long (the longest study of its kind to date) is to answer the main question: Can ILI and weight loss help prevent/delay the heart and circulatory problems which are the most common complications of type 2 – strokes, heart attacks and untimely death?
The goals of ILI:
- achieve 7% or greater weight loss at 1 year
- at least 175 minutes of physical activity per week
- calorie goal of 1200 to 1800 cals/day (depending on sex and size)
- less than 30% of cals as fat
- minimum of 15% of cals as protein
- use of portion-controlled meals and meal replacements
For support ILI participants were seen weekly for the first 6 months and 3 times per month for the next 6 months with group and one on one contact. During years 2 through 4 people were seen at least once a month individually, received follow-up at least monthly and were invited to group classes and activities to support their efforts. (Don’t you just dream of this amount of support at no cost! Participants were also provided with the meal replacements.)
In contrast the control group (DSE) was invited to 3 group sessions each year.
The lifestyle counselors were registered dietitians, behavioral counselors or exercise specialists.
To the Look AHEAD results: Impressive!
- Weight Loss: In the ILI group the mean maximal weight loss at one year was 8.6%. (Many studies have shown maximal weight loss is at one year.) At 4 years the ILI group maintained a mean weight loss of about 5% compared with about 1% in DSE. The rate of weight regain (also commonly seen in weight loss studies) in the ILI group appears to be slowing overtime.
- Fitness: Increased by about 20% in ILI and 5% DSE by year one. At 4 years ILI fitness level was about 5% from the study’s start and over baseline, and interestingly about 1% below the study start for DSE participants.
- Glucose, blood pressure and lipids (blood fats): ILI participants continued to have greater improvements in systolic blood pressure (BP) (the lower number), A1c and HDL-C (the good cholesterol) than DSE at 4 years. These differences were most apparent at year one and not all of these initial improvements were maintained at 4 years. A greater proportion of ILI participants hit the A1c target of <7% advised by the American Diabetes Association. For BP this was true years 1 through 3. Translated these results show that people in ILI group spent more time (over years) at lower risk of heart and blood vessel problems.
- Use of drugs to improve glucose , blood pressure and lipids: By years 3 and 4 DSE people had a greater decrease in LDL-C (bad cholesterol) than ILI participants, but they were using more medications to improve this number (such as statins). A greater proportion of ILI than DSE participants discontinued use of BP or glucose-lowering drugs. And among ILI participants not using any of these drugs at the start of the study, fewer people started them.
So, ILI positively impacted glucose, blood pressure and lipids - The ABCs of diabetes care.
Stay tuned for future results from Look AHEAD. Eventually we’ll see if maintaining even a small amount of weight loss, healthy changes in food choices and eating habits, a good bit of regular physical activity and SUPPORT can decrease heart and blood vessel problems in people with type 2 diabetes.
But do you need to wait to apply these results in your life or tell a loved one or friend about them? NO! Especially if you are among the 79 million people in the U.S. with prediabetes or are in the early years of type 2 (when these actions likely have their biggest bang for your efforts)!
There’s now an overwhelming amount of research reinforcing the importance of getting to and maintaining a healthy weight, eating healthfully and staying physically active. Yes, at this point you’d think these 4 year Look AHEAD conclusions are a ‘dah’ – but apparently not. Help me get these powerful results out with the message – TAKE ACTION NOW! An added plus: these healthy lifestyle behaviors have many other health and disease prevention benefits beyond preventing type2 diabetes or improving type 2 management.