Affiliation:
1. Department of Epidemiology and Prevention, Wake Forest University School of Medicine , Winston-Salem, NC 27157 , USA
2. Department of Medicine, Johns Hopkins School of Medicine , Baltimore, MD 21205 , USA
3. Department of Medicine, Baylor College of Medicine , Houston, TX 77030 , USA
4. Department of Preventive Medicine, University of Tennessee Health Science Center , Memphis, TN 38163 , USA
5. Department of Biostatistics and Data Science, Wake Forest University School of Medicine , Winston-Salem, NC 27157 , USA
6. Department of Internal Medicine, Wake Forest University School of Medicine , Winston-Salem, NC 27157 , USA
Abstract
Abstract
Purpose
We reevaluated the Action for Health in Diabetes (Look AHEAD) intensive lifestyle intervention (ILI) to assess whether the effect of ILI on cardiovascular disease (CVD) prevention differed by baseline glycated hemoglobin (HbA1c).
Methods
Look AHEAD randomized 5145 adults, aged 45 to 76 years with type 2 diabetes and overweight/obesity to ILI or a diabetes support and education (DSE) control group for a median of 9.6 years. ILI focused on achieving weight loss through decreased caloric intake and increased physical activity. We assessed the parent trial's primary composite CVD outcome. We evaluated additive and multiplicative heterogeneity of the intervention on CVD risk by baseline HbA1c.
Results
Mean baseline HbA1c was 7.3% (SD 1.2) and ranged from 4.4% (quintile 1) to 14.5% (quintile 5). We observed additive and multiplicative heterogeneity of the association between ILI and CVD (all P < .001) by baseline HbA1c. Randomization to ILI was associated with lower CVD risk for HbA1c quintiles 1 [hazard ratio (HR): 0.68, 95% confidence interval (CI): 0.53, 0.88] and 2 (HR: 0.80, 95% CI: 0.66, 0.96) and associated with higher CVD risk for HbA1c quintile 5 (HR: 1.27, 95% CI: 1.02, 1.58), compared to DSE.
Conclusion
Among adults with type 2 diabetes and overweight/obesity, randomization to a lifestyle intervention was differentially associated with CVD risk by baseline HbA1c such that it was associated with lower risk at lower HbA1c levels and higher risk at higher HbA1c levels. There is a critical need to develop and tailor lifestyle interventions to be successful for individuals with type 2 diabetes and high HbA1c.
Funder
National Institute of Diabetes and Digestive and Kidney Diseases
National Heart, Lung, and Blood Institute
National Institute of Nursing Research
National Center on Minority Health and Health Disparities
National Institutes of Health Office of Research on Women’s Health
Centers for Disease Control and Prevention
Intramural Research Program of the National Institute of Diabetes and Digestive and Kidney Diseases
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
Memphis General Clinical Research Center
General Clinical Research Center
Clinical & Translational Science Award
National Institutes of Health
VA Puget Sound Health Care System Medical Research Service
Department of Veterans Affairs
Frederic C. Bartter General Clinical Research Center
FedEx Corporation
Health Management Resources
LifeScan, Inc
Johnson & Johnson Company
Nestle HealthCare Nutrition, Inc
Hoffmann-La Roche Inc
Abbott Nutrition
Slim-Fast Brand of Unilever North America
Subject
Biochemistry (medical),Clinical Biochemistry,Endocrinology,Biochemistry,Endocrinology, Diabetes and Metabolism