The LOOK Ahead Trial: Four-Year Outcomes of an Intensive Lifestyle Intervention in Type 2 Diabetes

Lori Alexander

doi:10.1177/155989771108017

Summary

The primary objective of The Action for Health in Diabetes [Look AHEAD] Trial is to examine the long-term effects of an intensive lifestyle intervention that is designed to achieve and maintain weight loss by decreasing caloric intake and increasing physical activity in overweight or obese volunteers with type 2 diabetes. Participants in this program will be compared with controls who are involved in diabetes support and education (usual care).

Cardiometabolic Disorder
Diabetes Mellitus
Prevention & Screening

The primary objective of The Action for Health in Diabetes (Look AHEAD) Trial is to examine the long-term effects of an intensive lifestyle intervention (ILI) that is designed to achieve and maintain weight loss by decreasing caloric intake and increasing physical activity in overweight or obese volunteers with type 2 diabetes. Participants in this program will be compared with controls who are involved in diabetes support and education (DSE, usual care).

A multicenter, randomized, controlled trial on the long-term (13.5 years) effects of ILI on cardiovascular morbidity and mortality (ie, the incidence of cardiovascular disease [CVD], death, nonfatal myocardial infarction, nonfatal stroke, and hospitalization) in this population. The study includes 5145 participants and is planned through June 30, 2015.

Xavier Pi-Sunyer, MD, St. Luke's Roosevelt Hospital Columbia University, New York, New York, USA, described the study design in detail, as well as key results over 4 years [Look AHEAD Research Group et al. Diabetes Care 2007; Look AHEAD Research Group et al. Arch Intern Med 2010].

Averaged across 48 months, ILI participants had a greater percentage of weight loss than DSE participants (−6.15% vs −0.88%; p<0.001) and greater improvements in treadmill fitness (12.74% vs 1.96%; p<0.001), HbA1C level (−0.36% vs −0.09%; p<0.01), systolic (−5.33 vs −2.97 mm Hg; p<0.001) and diastolic (−2.92 vs −2.48 mm Hg; p=0.1) blood pressure, and levels of high-density lipoprotein cholesterol (3.67 vs 1.97 mg/dL; p<0.001) and triglycerides (−25.56 vs −19.75 mg/dL; p<0.001) [Look AHEAD Research Group et al. Arch Intern Med 2010].

Reductions in low-density lipoprotein cholesterol were greater in DSE than ILI participants (−12.84 vs −11.27 mg/dL; p=0.009), due to greater use of lipid-lowering medications in the DSE group. At 4 years, ILI participants maintained greater improvements than DSE participants in weight, fitness, HbA1C levels, systolic blood pressure, and high-density lipoprotein cholesterol levels [Look AHEAD Research Group et al. Arch Intern Med 2010].

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