Intensive Lifestyle Intervention May Prevent Disability in Type 2 Diabetes

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Overweight and obese patients with type 2 diabetes benefited from an intensive lifestyle intervention.
Overweight and obese patients with type 2 diabetes benefited from an intensive lifestyle intervention.

NEW ORLEANS — A lifestyle-based, intensive weight loss intervention may lead to significant delays in the onset of physical disability and significant increases in the number of non-disabled life years in overweight and obese adults with type 2 diabetes, according to a new study.

Researchers reported the findings at the American Diabetes Association (ADA) 76th Scientific Sessions.

The study demonstrated that long-term lifestyle interventions among overweight or obese adults with type 2 diabetes had a modest but significant effect on long-term disability. Researchers found that the effect on active life expectancy appeared to be greater than the effect on total life expectancy. 

“This is the first randomized study that we are aware of to examine the impact of an intervention, in this case weight loss, on the number of remaining active and disabled years of life.  We were not fully surprised by these findings, as prior studies have shown reductions in the rate of disability from weight loss,” said study investigator Edward Gregg, PhD, chief of the Epidemiology and Statistics Branch in the Division of Diabetes Translation at the Centers for Disease Control (CDC) and Prevention in Atlanta, Georgia.

Dr Gregg and his colleagues conducted a new analysis using data from the Look AHEAD Trial, which demonstrated that lifestyle interventions may greatly impact how disabled a person is later in life. The researchers examined the impact of the Look AHEAD lifestyle intervention on the number of remaining active and disabled years of life before death.  

The analysis included 5145 overweight or obese adults who aged 45 and 76 years. All participants had type 2 diabetes and were randomly assigned to an average of 10 years of intensive weight loss intervention or diabetes support and education.

The participants in this study were assessed for physical function at yearly visits using the SF-36. The researchers defined disability by onset of a major mobility limitation. For this investigation, the researchers used Poisson regression models to estimate the annual incidence of disability, mortality, and remission from disability. A Markov model was employed to estimate the age of disability onset and remaining years of life spent disabled and non-disabled.

The study demonstrated that the incidence of disability was significantly lower in the intensive weight loss intervention group compared with the diabetes support and education group (6% vs 6.8%).

“Clinicians should care about this because diabetes has been shown to lead to substantial increases in risk of physical disability and to speed up the onset of disability by 6 to 7 years. This study shows that weight loss may be expected to affect the number of active years that their older patients will have,” Dr Gregg told Endocrinology Advisor.  

He said the intensive weight loss intervention was associated with a significant delay in the age of onset of disability and a significant increase in the number of non-disabled years of life, regardless of age or gender. 

For an average 60 year old, the intensive weight loss intervention resulted in an increase non-disabled years of life (12.1 vs 11.3 years).  The intensive weight loss intervention also led to a delay in disability onset (age, 72.1 vs 71.3 years) and helped decrease the number of years of life spent disabled before death (14.7 vs 15.2 years).

Dr Gregg said that over a period of 12 years, the Look AHEAD Study found no effect of intensive weight loss intervention on the incidence of major cardiovascular disease events. However, the study showed improvements in chronic kidney disease, depression, sleep apnea, and diabetes remission.

“Weight loss through adoption of healthier lifestyle leads to diverse health benefits among older adults with diabetes.  This study shows that lifestyle intervention has an important effect on the number of active vs disabled years of life and that this impact on active life expectancy is greater than the effect on total life expectancy,” said Dr Gregg.

Disclosures: Dr Gregg reports no financial disclosures. Several other researchers disclosed financial ties to Takeda, Boehringer Ingelheim, Janssen, or Terumo.

Reference

  1. Gregg EW, Lin J, Bardenheier B, et al. Abstract 169-OR. Impact of Intensive Lifestyle Intervention on the Compression of Lifetime Disability: The Look AHEAD Trial. Presented at: ADA 76th Scientific Sessions; June 10-14, 2016; New Orleans, LA.
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