期刊
DIABETES CARE
卷 44, 期 5, 页码 1203-1210出版社
AMER DIABETES ASSOC
DOI: 10.2337/dc20-2372
关键词
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资金
- National Institutes of Health (NIH)
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) [DK57136, DK57149, DK56990, DK57177, DK57171, DK57151, DK57182, DK57131, DK57002, DK57078, DK57154, DK57178, DK57219, DK57008, DK57135, DK56992]
- 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
- Johns Hopkins Medical Institutions Bayview General Clinical Research Center [M01RR02719]
- Massachusetts General Hospital Mallinckrodt General Clinical Research Center
- Massachusetts Institute of Technology General Clinical Research Center [M01RR01066]
- Harvard Clinical and Translational Science Center [RR025758-04]
- University of Colorado Health Sciences Center General Clinical Research Center [M01RR00051]
- ClinicalNutrition Research Unit [P30DK48520]
- University of Tennessee at Memphis General Clinical Research Center [M01RR0021140]
- University of Pittsburgh General Clinical Research Center [M01RR000056]
- Clinical Translational Research Center - Clinical and Translational Science Award [UL1 RR 024153]
- NIH [DK 046204]
- VA Puget Sound Health Care System Medical Research Service, Department of Veterans Affairs
- Frederic C. Bartter General Clinical Research Center [M01RR01346]
- NIDDK [DK110341]
In this study, researchers found that among overweight and obese adults with type 2 diabetes, lifestyle intervention was associated with differential risk for cardiovascular disease based on diabetes subgroups. Specifically, ILI was associated with increased risk for cardiovascular disease in the poor glucose control subgroup.
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.
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