Hampton Hotels Santa Clarita - Weight Loss No Help For Heart In Diabetes

Source - http://www.medpagetoday.com/
By - Charlene Laino
Category - Hampton Hotels Santa Clarita
Posted By - Hampton Inn Santa Clarita

Hampton Hotels Santa Clarita

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, according to final results of the randomized controlled Look AHEAD trial.

The study was halted in September on the basis of a futility analysis that showed no significant differences in the composite primary outcome of death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for angina between those who had the intervention and those who only received support: 1.83 versus 1.92 events per 100 person-years, respectively (P=0.51).

Rena Wing, PhD, of Brown University, and colleagues reported their findings simultaneously online in the New England Journal of Medicine and at the American Diabetes Association meeting here.

Nonetheless, people in the intervention group benefited in terms of a host of other ways, Mary Evans, PhD, director of Look AHEAD at the National Institute of Diabetes and Digestive and Kidney Diseases, told The Gupta Guide.

"They sustained 6% weight loss over 10 years. They had clinically meaningful improvements in glycated hemoglobin levels and less diabetes and less retinopathy. There were also improvements in quality of life and reduction in depression," she said.

Evans said explanations for the lack of benefit among people in the intervention group include greater use of medications in the control group. "The drugs, particularly statins, could have lowered their risk of cardiovascular disease.

"Or perhaps people in the intervention group didn't achieve enough weight loss," she said.

The Look AHEAD (Action for Health in Diabetes) trial enrolled 5,145 overweight or obese patients with type 2 diabetes at 16 centers in the U.S.

Patients were randomized to either an intensive lifestyle intervention that focused on cutting calories and increasing physical activity or to a control group that only received diabetes support and education.

When the trial was stopped in September 2012, the median follow-up time was 9.6 years.

Weight loss was greater in the intervention group than in the control group throughout the study (8.6% versus 0.7% at 1 year; 6.0% versus 3.5% at study end).

The intense lifestyle change also produced greater initial improvements in fitness and cardiovascular risk factors, except for LDL cholesterol. But the between-group differences diminished over time.

As for adverse events, the rate of self-reported fractures was significantly higher in the intervention group: 2.51 versus 2.16 per 100 person-years in the control group (P=0.01). However, there was no significant difference in the rate of adjudicated fractures (1.66 and 1.64 per 100 person-years, respectively).

A limitation of the study is that patients who were motivated to lose weight were recruited, so the findings may not generalize to all patients, the researchers said.

In an accompanying editorial, Hertzel Gerstein, MD, of the University of Hamilton in Ontario in Canada, wrote, "Even with no clear evidence of cardiovascular benefit, the Look AHEAD investigators have shown that attention to activity and diet can safely reduce the burden of diabetes and have reaffirmed the importance of lifestyle approaches as one of the foundations of modern diabetes care."