medwireNews: Analysis of data from the Look AHEAD trial suggests that a long-term intensive lifestyle intervention could delay the onset of physical disability among overweight and obese patients with type 2 diabetes.
However, the intervention was not associated with an increase in total life expectancy, so the overall effect was to reduce the number of years people spent living with physical disability, report Edward Gregg (Centers for Disease Control and Prevention, Atlanta, Georgia, USA) and study co-authors.
As reported in Diabetes Care, the team estimated that an average 50-year-old participant who received the lifestyle intervention had 15.3 years without disability, became disabled at the age of 65.3 years, and lived with disability for 20.7 years before death. And a typical patient of the same age from the control group had 14.4 years without disability before becoming disabled at the age of 64.4 years and living with disability for 21.5 years.
The researchers used a Markov model to estimate disability-free life expectancy – measured based on Short Form-36 physical function scores – among trial participants who were randomly assigned to receive a 10-year lifestyle intervention involving caloric restriction and physical activity, or to receive a control intervention comprising diabetes support and education.
The 2567 patients who received the intervention had a significant 0.8–0.9 year delay in the onset of moderate or severe disability, and a corresponding increase in the number of years without disability, compared with the 2570 patients in the control group, but there was no significant difference in overall life expectancy between the two groups.
Moreover, the incidence of physical disability over 12 years of follow-up was significantly lower among participants receiving the lifestyle intervention, with annual rates of 6.0% versus 6.8% for the control group.
In subgroup analyses, the lifestyle intervention was associated with a significant reduction in the incidence of disability among women and those without prior cardiovascular disease (CVD), but there was no significant association among men and those with CVD.
Taken together, these findings indicate that “an [intensive lifestyle intervention] that focuses on caloric restriction and increased physical activity can reduce long-term physical disability and has an impact on disability-free life expectancy despite not affecting total life expectancy,” write Gregg and colleagues.
And they conclude: “Given the large increases in life span observed and the continued high national prevalence of type 2 diabetes in older adults, these findings indicate that lifestyle interventions can play an important role in compressing population morbidity.”
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