Racial/ethnic and socioeconomic disparities in weight outcomes, cardiovascular events, and mortality in the look AHEAD trial

Background: Intensive lifestyle interventions (ILI) for type 2 diabetes (T2D) improve health outcomes, but participants from different races/ethnicities or socioeconomic status may not benefit equally.Methods: Within the Look AHEAD trial, we examined achievement of the 7% weight loss goal, as well as secondary weight, cardiovascular, and mortality outcomes, by race/ethnicity and educational attainment (EA).Results: Among 4,640 participants (31 % Black or Hispanic, 13 % with less than a high school degree), Black and Hispanic participants were less likely than White participants to achieve 7 % weight loss in both the ILI (45.8 % v. 60.7 %, p < 0.001 and 53.0 % v. 60.7 %, p = 0.01, respectively) and diabetes support and education (DSE) arms. Contrastingly, participants with less than a high school degree were more likely in the ILI but less likely in the DSE arm to achieve this goal, with a significant arm by EA interaction. Hispanic participants and those with lowest EA also experienced decreased mortality in the ILI versus the DSE arm.Conclusions: All Look AHEAD participant subgroups achieved greater weight loss from ILI; however, Black and Hispanic participants lost less weight than White participants in both arms, while those with lowest EA benefited disproportionately from the ILI compared to participants with higher EA.

Automated summary

Participants from different races/ethnicities or socioeconomic status may not benefit equally in intensive lifestyle interventions for type 2 diabetes. Black and Hispanic participants had less weight loss compared to White participants, while participants with lower educational attainment benefited more from the interventions.