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28-09-2017 | Type 2 diabetes | Book chapter | Article

12. Diabetes Prevention Program (DPP) and the Action for Health in Diabetes (Look AHEAD) Study: Lessons Learned

Authors: Bethany Barone Gibbs, PhD, John M. Jakicic, PhD

Publisher: Springer International Publishing

Abstract

The Diabetes Prevention Program (DPP) and the Action for Health in Diabetes (Look AHEAD) Study were important, large, randomized trials that evaluated the effects of a lifestyle intervention, including diet and physical activity, in persons at risk for or with type 2 diabetes. The DPP Study found that a lifestyle intervention targeting ≥7% weight loss and ≥150 min/week of physical activity effectively reduced diabetes incidence by 58% over an average of 2.8 years. Though weight loss was a stronger predictor of decreased diabetes incidence in DPP, achieving the targeted 150 min/week of physical activity predicted greater weight loss, was easier for participants to achieve (vs. the weight loss target), and decreased diabetes risk by 44% even when weight loss and dietary fat goals were not achieved. These findings strongly support physical activity for diabetes prevention. The Look AHEAD Study evaluated whether a lifestyle intervention targeting ≥7% weight loss and ≥175 min/week of physical activity could reduce major cardiovascular events in adults with preexisting diabetes. After an average 9.6 years of follow-up, the lifestyle intervention was not effective for reducing cardiovascular events as compared to the control group. Despite the failure to find a benefit on the primary outcome, increases in physical activity and, to a greater extent, cardiorespiratory fitness were independently related to more weight loss, better glycemic control, reduced cardiovascular risk factors, and increased health-related quality of life among Look AHEAD Study participants. Thus, physical activity that increases fitness remains an important part of treatment recommendations for adults with type 2 diabetes.
Literature
1.
The Diabetes Prevention Program. Design and methods for a clinical trial in the prevention of type 2 diabetes. Diabetes Care. 1999;22(4):623–34.CrossRef
2.
Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393–403.CrossRefPubMed
3.
The Diabetes Prevention Program (DPP). Description of lifestyle intervention. Diabetes Care. 2002;25(12):2165–71.CrossRef
4.
U.S. Department of Health and Human Services. 2008 Physical activity guidelines for Americans. 2008. p. 21–8.
5.
Colberg SR, Sigal RJ, Fernhall B, Regensteiner JG, Blissmer BJ, Rubin RR, et al. Exercise and type 2 diabetes: the American College of Sports Medicine and the American Diabetes Association: joint position statement executive summary. Diabetes Care. 2010;33(12):2692–6.CrossRefPubMedPubMedCentral
6.
Knowler WC, Fowler SE, Hamman RF, Christophi CA, Hoffman HJ, Brenneman AT, et al. 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. Lancet. 2009;374(9702):1677–86.CrossRefPubMed
7.
Diabetes Prevention Program Outcomes Study Research G, Orchard TJ, Temprosa M, Barrett-Connor E, Fowler SE, Goldberg RB, et al. Long-term effects of the Diabetes Prevention Program interventions on cardiovascular risk factors: a report from the DPP Outcomes Study. Diabet Med. 2013;30(1):46–55.CrossRef
8.
Diabetes Prevention Program Research G. The 10-year cost-effectiveness of lifestyle intervention or metformin for diabetes prevention: an intent-to-treat analysis of the DPP/DPPOS. Diabetes Care. 2012;35(4):723–30.CrossRef
9.
Diabetes Prevention Program Research G. Within-trial cost-effectiveness of lifestyle intervention or metformin for the primary prevention of type 2 diabetes. Diabetes Care. 2003;26(9):2518–23.CrossRef
10.
Wing RR, Hamman RF, Bray GA, Delahanty L, Edelstein SL, Hill JO, et al. Achieving weight and activity goals among diabetes prevention program lifestyle participants. Obes Res. 2004;12(9):1426–34.CrossRefPubMed
11.
Hamman RF, Wing RR, Edelstein SL, Lachin JM, Bray GA, Delahanty L, et al. Effect of weight loss with lifestyle intervention on risk of diabetes. Diabetes Care. 2006;29(9):2102–7.CrossRefPubMedPubMedCentral
12.
Kriska AM, Edelstein SL, Hamman RF, Otto A, Bray GA, Mayer-Davis EJ, et al. Physical activity in individuals at risk for diabetes: Diabetes Prevention Program. Med Sci Sports Exerc. 2006;38(5):826–32.CrossRefPubMedPubMedCentral
13.
Florez H, Pan Q, Ackermann RT, Marrero DG, Barrett-Connor E, Delahanty L, et al. Impact of lifestyle intervention and metformin on health-related quality of life: the diabetes prevention program randomized trial. J Gen Intern Med. 2012;27(12):1594–601.CrossRefPubMedPubMedCentral
14.
Ryan DH, Espeland MA, Foster GD, Haffner SM, Hubbard VS, Johnson KC, et al. Look AHEAD (Action for Health in Diabetes): design and methods for a clinical trial of weight loss for the prevention of cardiovascular disease in type 2 diabetes. Control Clin Trials. 2003;24(5):610–28.CrossRefPubMed
15.
Look ARG, Wing RR, Bolin P, Brancati FL, Bray GA, Clark JM, et al. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N Engl J Med. 2013;369(2):145–54.CrossRef
16.
Look ARG, Wadden TA, West DS, Delahanty L, Jakicic J, Rejeski J, et al. The Look AHEAD study: a description of the lifestyle intervention and the evidence supporting it. Obesity (Silver Spring). 2006;14(5):737–52.CrossRef
17.
Wesche-Thobaben JA. The development and description of the comparison group in the Look AHEAD trial. Clin Trials. 2011;8(3):320–9.CrossRefPubMed
18.
Phelan S, Kanaya AM, Subak LL, Hogan PE, Espeland MA, Wing RR, et al. Weight loss prevents urinary incontinence in women with type 2 diabetes: results from the Look AHEAD trial. J Urol. 2012;187(3):939–44.CrossRefPubMedPubMedCentral
19.
Rubin RR, Wadden TA, Bahnson JL, Blackburn GL, Brancati FL, Bray GA, et al. Impact of intensive lifestyle intervention on depression and health-related quality of life in type 2 diabetes: the Look AHEAD trial. Diabetes Care. 2014;37(6):1544–53.CrossRefPubMed
20.
Ribisl PM, Gaussoin SA, Lang W, Bahnson J, Connelly SA, Horton ES, et al. Lifestyle intervention improves heart rate recovery from exercise in adults with type 2 diabetes: results from the Look AHEAD study. J Obes. 2012;2012:309196.CrossRefPubMedPubMedCentral
21.
Foy CG, Lewis CE, Hairston KG, Miller GD, Lang W, Jakicic JM, et al. Intensive lifestyle intervention improves physical function among obese adults with knee pain: findings from the Look AHEAD trial. Obesity (Silver Spring). 2011;19(1):83–93.CrossRef
22.
Espeland MA, Glick HA, Bertoni A, Brancati FL, Bray GA, Clark JM, et al. Impact of an intensive lifestyle intervention on use and cost of medical services among overweight and obese adults with type 2 diabetes: the action for health in diabetes. Diabetes Care. 2014;37(9):2548–56.CrossRefPubMedPubMedCentral
23.
Steinberg H, Jacovino C, Kitabchi AE. Look inside Look AHEAD: why the glass is more than half-full. Curr Diab rep. 2014;14(7):500.CrossRefPubMed
24.
Despres JP, Poirier P. Diabetes: looking back at Look AHEAD – giving lifestyle a chance. Nat Rev Cardiol. 2013;10(4):184–6.CrossRefPubMed
25.
Jakicic JM, Egan CM, Fabricatore AN, Gaussoin SA, Glasser SP, Hesson LA, et al. Four-year change in cardiorespiratory fitness and influence on glycemic control in adults with type 2 diabetes in a randomized trial: the Look AHEAD trial. Diabetes Care. 2013;36(5):1297–303.CrossRefPubMedPubMedCentral
26.
Wadden TA, Neiberg RH, Wing RR, Clark JM, Delahanty LM, Hill JO, et al. Four-year weight losses in the Look AHEAD study: factors associated with long-term success. Obesity (Silver Spring). 2011;19(10):1987–98.CrossRefPubMedCentral
27.
Wadden TA, West DS, Neiberg RH, Wing RR, Ryan DH, Johnson KC, et al. One-year weight losses in the Look AHEAD study: factors associated with success. Obesity (Silver Spring). 2009;17(4):713–22.CrossRefPubMedCentral
28.
Gregg EW, Chen H, Wagenknecht LE, Clark JM, Delahanty LM, Bantle J, et al. Association of an intensive lifestyle intervention with remission of type 2 diabetes. JAMA. 2012;308(23):2489–96.CrossRefPubMedPubMedCentral
29.
Gibbs BB, Brancati FL, Chen H, Coday M, Jakicic JM, Lewis CE, et al. Effect of improved fitness beyond weight loss on cardiovascular risk factors in individuals with type 2 diabetes in the Look AHEAD study. Eur J Prev Cardiol. 2014;21(5):608–17.CrossRefPubMed
30.
Williamson DA, Rejeski J, Lang W, Van Dorsten B, Fabricatore AN, Toledo K, et al. Impact of a weight management program on health-related quality of life in overweight adults with type 2 diabetes. Arch Intern Med. 2009;169(2):163–71.CrossRefPubMedPubMedCentral

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