Lifestyle Interventions to Prevent Early Disability in Type 2 DiabetesTuesday, April 10, 2012
Yesterday, I noted that, although in the short term, bariatric surgery may be the preferred treatment for individuals with diabetes, the vast majority of people with this condition will have little hope of ever being handed this ‘parachute’.
For most, medical management of diabetes will be the best they can hope for.
But hope they can – as shown in a report from the randomized controlled Look AHEAD trial (now in its 5th year) by Jack Rejiski and colleagues, published in the New England Journal of Medicine.
This paper reports the impact of the ongoing intensive lifestyle intervention, aimed at achieving and maintaining a ~7% weight loss together with increased physical activity, to a diabetes support-and-education program in over 10,000 overweight or obese adults between the ages of 45 and 74 years with type 2 diabetes.
At year 4, participants randomised to the lifestyle-intervention group had a relative reduction of 48% in the risk of loss of mobility, as compared with the support group. Both weight loss (approximately 6.5%) and improved fitness (as assessed on treadmill testing) were significant mediators of this effect.
Thus, as the authors conclude, even modest weight loss together with improved fitness slowed the decline in mobility in overweight adults with type 2 diabetes even over this rather short four years of the study.
While these results may appear modest in the light of yesterday’s report on surgical outcomes, let us remember, that we are here talking about a study with over 10,000 participants, compared to the just over 200 participants in the surgical trials (not to mention the remarkably longer follow-up of this ‘lifestyle’ study).
This is the reality of the situation – while surgery can ever only be a solution for a vanishingly small proportion of the over 300 million people living with diabetes today, the lifestyle interventions of the Look AHEAD trial, with its significant and clinically meaningful outcomes, could indeed be offered to virtually anyone, who should happen to develop this condition.
Let us also remember, that much of the infrastructure and personnel that would need to be put in place to assure the long-term outcomes of bariatric surgery, are not all that different from what would be needed to better manage diabetes.
Rejeski WJ, Ip EH, Bertoni AG, Bray GA, Evans G, Gregg EW, Zhang Q, & Look AHEAD Research Group (2012). Lifestyle change and mobility in obese adults with type 2 diabetes. The New England journal of medicine, 366 (13), 1209-17 PMID: 22455415