Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes

Rena R. Wing, Paula Bolin, Frederick L. Brancati, George A. Bray, Jeanne M. Clark, Mace Coday, Richard S. Crow, Jeffrey M. Curtis, Caitlin M. Egan, Mark A. Espeland, Mary Evans, John P. Foreyt, Siran Ghazarian, Edward W. Gregg, Barbara Harrison, Helen P. Hazuda, James O. Hill, Edward S. Horton, S. Van Hubbard, John M. JakicicRobert W. Jeffery, Karen C. Johnson, Steven E. Kahn, Abbas E. Kitabchi, William C. Knowler, Cora E. Lewis, Barbara J. Maschak-Carey, Maria G. Montez, Anne Murillo, David M. Nathan, Jennifer Patricio, Anne Peters, Xavier Pi-Sunyer, Henry Pownall, David Reboussin, Judith G. Regensteiner, Amy D. Rickman, Donna H. Ryan, Monika Safford, Thomas A. Wadden, Lynne E. Wagenknecht, Delia S. West, David F. Williamson, Susan Z. Yanovski

Research output: Contribution to journalArticlepeer-review

2096 Scopus citations


BACKGROUND: Weight loss is recommended for overweight or obese patients with type 2 diabetes on the basis of short-term studies, but long-term effects on cardiovascular disease remain unknown. We examined whether an intensive lifestyle intervention for weight loss would decrease cardiovascular morbidity and mortality among such patients. METHODS: In 16 study centers in the United States, we randomly assigned 5145 overweight or obese patients with type 2 diabetes to participate in an intensive lifestyle intervention that promoted weight loss through decreased caloric intake and increased physical activity (intervention group) or to receive diabetes support and education (control group). The primary outcome was a composite of death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for angina during a maximum follow-up of 13.5 years. RESULTS: The trial was stopped early on the basis of a futility analysis when the median follow-up was 9.6 years. Weight loss was greater in the intervention group than in the control group throughout the study (8.6% vs. 0.7% at 1 year; 6.0% vs. 3.5% at study end). The intensive lifestyle intervention also produced greater reductions in glycated hemoglobin and greater initial improvements in fitness and all cardiovascular risk factors, except for low-density-lipoprotein cholesterol levels. The primary outcome occurred in 403 patients in the intervention group and in 418 in the control group (1.83 and 1.92 events per 100 person-years, respectively; hazard ratio in the intervention group, 0.95; 95% confidence interval, 0.83 to 1.09; P = 0.51). CONCLUSIONS: An intensive lifestyle intervention focusing on weight loss did not reduce the rate of cardiovascular events in overweight or obese adults with type 2 diabetes. (Funded by the National Institutes of Health and others; Look AHEAD number, NCT00017953.)

Original languageEnglish (US)
Pages (from-to)145-154
Number of pages10
JournalNew England Journal of Medicine
Issue number2
StatePublished - 2013

ASJC Scopus subject areas

  • Medicine(all)


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