Long-term benefits of diabetes intervention programme demonstrated

The long-term impact of an intensive lifestyle intervention on cardiovascular risk factors in people with type 2 diabetes has been proven in real-world clinical practice.

Results from a follow-up study of obese people with type 2 diabetes, who lost at least seven per cent of their body weight after one year of an intensive lifestyle intervention, show that those who sustained their weight loss maintained most of its benefits on HbA1c and cholesterol for five years.

Researchers from Joslin Diabetes Center evaluated the impact of sustained weight loss versus weight regain on cardiovascular risk factors in the real-world following attendance on an education programme.

They followed 129 obese people with type 2 diabetes enrolled in the US-based Weight Achievement and Intensive Treatment (Why WAIT) programme, a 12-week clinical model of intensive lifestyle intervention.

After one year, they were divided participants into group A, who maintained <seven per cent weight loss (47.3 per cent) and group B (52.7 ), who maintained ≥ seven per cent weight loss, continuing to follow them for five years.

The results published in BMJ Open Diabetes Research & Care saw the total cohort losing 23.8 lbs (−9.7 per cent) at 12 weeks and maintained −16.2 lbs (−6.4 per cent) at five years (p<0.001).

Group A maintained −8.4 lbs (−3.5 per cent) and group B maintained −23.1 lbs (−9.0 per cent) at five years. In group A, A1C decreased from 7.5±1.3 per cent to 6.7±0.9 per cent at 12 weeks but increased to 7.7±1.4 per cent at 1 year and 8.0±1.9 per cent at 5 years.

In group B, A1C decreased from 7.4±1.2 per cent to 6.4±0.9 per cent at 12 weeks and rose to 6.8±1.2 per cent at 1 year and 7.3±1.5 per cent at five years. Despite weight regain, group A maintained improvement in low-density lipoprotein-cholesterol and high-density lipoprotein-cholesterol with worsening of serum triglycerides and no change in blood pressure (BP).

Group B maintained improvement in lipid profile for five years and had significantly lower BP for 18 months.

The researchers concluded: “Conclusions Weight reduction in patients with diabetes can be maintained for 5 years and is predicted by patients’ ability to maintain ≥7 per cent weight loss at one year. A1C and triglycerides deteriorate with weight regain, while other lipid improvements are maintained. Sustained weight loss is associated with significantly lower A1C for five years and lowers BP for 18 months.”

Professor Osama Hamdy, medical director of Joslin’s obesity clinical program and assistant professor of medicine at Harvard Medical School, said: “This weight loss was very impressive, since we know from previous research that if this population can maintain a seven per cent weight loss, they show a marked improvement in insulin sensitivity and many other cardiovascular risk factors.”

The lead author on the study added: “To the best of our knowledge, this is the longest follow-up in the real world of clinical practice to show encouraging results that weight loss can be achieved and maintained.”

To view the paper, click here.