Diabetes? Weight Loss Can Help You Live Better If Not Longer
Tuesday, June 25, 2013
Regular readers may recall the previous post that the rather ambitious LookAHEAD trial, designed to study whether or not intensive lifestyle intervention targeting weight loss in patients with type 2 diabetes would save lives, was abandoned due to futility – in other words, the study was discontinued because it was deemed unlikely to meet its primary objective, i.e. to show survival benefits.
The paper describing this main outcome (or rather lack of it) is now published in the New England Journal of Medicine and is certain to once again spawn a barrage of media reports claiming that weight loss was useless in patients with type 2 diabetes.
This, in fact is not true. Indeed, the LookAHEAD trial, despite rather modest weight loss, very clearly demonstrated important quality of life benefits for participants in the intervention arm.
In addition, diabetic patients who lost weight benefitted from lowered HbA1c, reduced medications, increased physical fitness, less depression, as well as improved urinary incontinence, increased mobility, improved sleep apnea and improved sexual function.
Furthermore, participants who lost weight were more likely to experience remission of their type 2 diabetes over the four years of the trial.
While none of these benefits may be impressive to researchers, payers and regulators who would rather count body bags, these improvements are very real and substantial for the patients concerned.
Thus, while “body-bag enthusiasts” may deem the results of LookAHEAD as negative or “inconclusive”, I would look at LookAHEAD as a clear indication that intensive lifestyle intervention aimed at weight loss in patients with type 2 diabetes may well be a worthwhile endeavour.
Let’s never forget that life is not just about quantity – for some people quality counts too.
@DrSharma
Edmonton, AB
Tuesday, June 25, 2013
There are certainly some benefits, but I found the magnitude of some of the benefits pretty unimpressive. The absolute reduction in HBA1C was 0.1 (7.4 v 7.3) and the absolute reduction in insulin usage was 5% (41% v 35). There was no statistically significant difference in usage for other medications by the end of the trial.
The study I found on depression only published data from years 0 and 1, even though it was published in 2012 when presumably the data from years 2,3, and 4 (when patients had started regaining weight) were available.
The question also remains whether a focus on weight loss is a necessary component of the intensive lifestyle intervention.
Wednesday, June 26, 2013
Many new questions are raising when reading these results.
It’s impressive, the “regaining” in weight, waist circumference, HbA1c, .. after an initial positive result. Does this mean, a sustained effect of change in lifestyle is an illusion ?
What did really change in lifestyle after 5 years in the intervention group versus control group ? maybe traditional “education” has the same effect on change in lifestyle in the long run ?? How many patients did – after 5 years – effectively weekly “175 minutes of moderate intensity physical activity” in both groups ? How many patient did – after2 years effectively follow a “caloric restriction to minus 1800 kcal” in both groups ?
Maybe are GP’s after all doing not so bad by simply educating and following up our DM2 patients following actual guidelines 🙂 … (I am a GP in Western Europe)
“Every mm Hg lowering blood pressure has an effect on cardiovascular outcome”, so why not when it ‘s due to change in lifestyle ?
“Every % lowering HbA1c has an effect”, so why not when it’s due to change in lifestyle ?
Does this study indicate that better controling bloodpressure and diabetes by medication and traditional education and follow up by primary care overrrules a possible additonal effect of intensive lifestyle coaching ??? (there is also a weight loss, change in WC, HbA1c and physical fitness in the control group ! The control group didn’t reach the expected events during the first year …??? ) Does this mean correct use and titration of statins and antihypertensive drugs have more impact on cardiovascular events versus coaching lifestyle ??