DIABETES
October 14, 2010

Type 2 Diabetics, Good News

Lifestyle changes produced larger and longer-lasting health improvements than expected.

The best way to fight back against diabetes appears to be to lose weight and exercise more. That is no surprise, but the degree of improvement a recent large study has found is important news.

It's been known for some time that lifestyle changes can produce short-term improvement in blood sugar level and risk factors for heart disease in people with type 2 diabetes. But until recently, no long-term trial on the effects of lifestyle change had been done.

The Look Ahead trial was conducted on 5,145 overweight or obese individuals with type 2 diabetes. The average age of participants was 59 years old … Changes in lifestyle led to about seven times the weight loss seen in diabetics who were not in the lifestyle change program.

The Look AHEAD trial found that lifestyle changes produce health benefits that last for at least four years. Basically, participants were strongly encouraged to eat less and exercise more, and given the tools to help them do so.

The benefits included decreased blood pressure, improvements in fitness (by treadmill test), decreased hemoglobin A1c levels (indicating lower blood sugar), lower blood triglycerides and higher HDL (good) cholesterol level. Changes in lifestyle also led to about seven times the weight loss seen in diabetics who were not in the lifestyle change program.

The lifestyle change program began with regular meetings with a lifestyle counselor. Participants were given specific calorie consumption and exercise goals, encouraged to keep calorie and exercise diaries and were taught skills to improve their problem solving and goal setting. After the first year, the meetings were cut down to once monthly, with at least one additional phone or e-mail contact each month. Participants were also encouraged to attend additional group classes.

A major goal was to lose 7% of total weight in the first year and to keep it off afterwards.

The Look Ahead trial was conducted on 5,145 overweight or obese individuals with type 2 diabetes. The average age of participants was 59 years old and about 60% of the participants were female. Participants were placed into two groups. The first group received the intensive lifestyle interventions previously mentioned. The members of the other group were invited to thrice yearly group sessions focused on diet, physical activity or social support. These members were not weighed at these sessions nor were they counseled on behavioral strategies to reduce calories or increase exercise. Four years later, the two groups were compared.

The only measure in which the lifestyle intervention group members came out second best was in lowering their LDL (bad) cholesterol level. This was attributed to the other group's increased usage of cholesterol lowering medications. Apparently, doctors did not feel the need to prescribe cholesterol lowering medications to as many members of the lifestyle intervention group over the four-year period, presumably because their cholesterol level was not as high as members of the other group.

A primary concern of the Look AHEAD trial was reducing heart disease and mortality in diabetics. People with type 2 diabetes have a much higher risk of developing heart disease than members of the general population and also die younger. The trial is ongoing, and it will still take many years to tell if the benefits seen from lifestyle interventions translate into reduced heart disease and longer life. Right now, it shows that diabetics who change their lifestyle appear to be much healthier than those who don't.

An article detailing the Look Ahead study was published in the September 27, 2010 issue of Archives of Internal Medicine.

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