Affiliation:
1. Wake Forest School of Medicine, Winston-Salem, NC
2. Baylor College of Medicine, Houston, TX
3. VA Puget Sound Health Care System and University of Washington, Seattle, WA
4. Johns Hopkins School of Medicine, Baltimore, MD
Abstract
OBJECTIVE
We reevaluated the Action for Health in Diabetes (Look AHEAD) intervention, incorporating diabetes subgroups, to identify whether intensive lifestyle intervention (ILI) is associated with differential risk for cardiovascular disease (CVD) by diabetes subgroup.
RESEARCH DESIGN AND METHODS
In the Look AHEAD trial, 5,145 participants, aged 45–76 years, with type 2 diabetes (T2D) and overweight or obesity were randomly assigned to 10 years of ILI or a control condition of diabetes support and education. The ILI focused on weight loss through decreased caloric intake and increased physical activity. To characterize diabetes subgroups, we applied k-means clustering to data on age of diabetes diagnosis, BMI, waist circumference, and glycated hemoglobin. We examined whether relative intervention effects on the trial’s prespecified CVD outcomes varied among diabetes subgroups.
RESULTS
We characterized four subgroups related to older age at diabetes onset (42% of sample), poor glucose control (14%), severe obesity (24%), and younger age at diabetes onset (20%). We observed interactions (all P < 0.05) between intervention and diabetes subgroups for three separate composite cardiovascular outcomes. Randomization to ILI was associated with increased risk for each cardiovascular outcome only among the poor-glucose-control subgroup (hazard ratio >1.32). Among the three other diabetes subgroups, ILI was not associated with increased risk for CVD.
CONCLUSIONS
Among overweight and obese adults with T2D, a lifestyle intervention was associated with differential risk for CVD that was dependent on diabetes subgroup. Diabetes subgroups may be important to identify the patients who would achieve benefit and avoid harm from an ILI.
Funder
National Institutes of Health
National Heart, Lung, and Blood Institute
National Institute of Nursing Research
National Center on Minority Health and Health Disparities
NIH Office of Research on Women’s Health
Centers for Disease Control and Prevention
Intramural Research Program of the NIDDK
The Johns Hopkins Medical Institutions Bayview General Clinical Research Center
Massachusetts General Hospital Mallinckrodt General Clinical Research Center
Massachusetts Institute of Technology General Clinical Research Center
Harvard Clinical and Translational Science Center
University of Colorado Health Sciences Center General Clinical Research Center
Clinical Nutrition Research Unit
University of Tennessee at Memphis General Clinical Research Center
University of Pittsburgh General Clinical Research Center
Clinical Translational Research Center
Clinical and Translational Science Award
VA Puget Sound Health Care System Medical Research Service
Department of Veterans Affairs
Frederic C. Bartter General Clinical Research Center
NIDDK
Publisher
American Diabetes Association
Subject
Advanced and Specialized Nursing,Endocrinology, Diabetes and Metabolism,Internal Medicine