1. Strategies for Improving Care

,

doi:10.2337/dc15-s004

Cited by 80 publications

(31 citation statements)

References 42 publications

(25 reference statements)

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“…Treatment recommendations have included both lifestyle modification and medication for management of T2DM and CVD risk, tailored to patient preferences (36). The Look AHEAD results are consistent with these recommendations, and many ILI participants were on various medications for such management; however, intensive lifestyle modification could play a more central role depending on patient preferences.…”

Section: Implications For Preventive Cardiologymentioning

confidence: 99%

The Look AHEAD Trial: Implications for Lifestyle Intervention in Type 2 Diabetes Mellitus

Dutton

Lewis

2015

Progress in Cardiovascular Diseases

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Given the array of adverse health consequences of obesity, including increased risk for type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD), the Look AHEAD trial (N=5,145) was conducted to test the hypothesis that an intensive lifestyle intervention (ILI) for weight loss would achieve significantly greater reductions in CVD morbidity and mortality than a control condition of diabetes support and education (DSE) among participants with T2DM. A number of significant and long-term improvements were observed for ILI, including body weight, physical fitness and physical function, glucose control, quality-of-life (QoL), and healthcare costs. However, ILI did not significantly reduce CVD-related morbidity/mortality (i.e., CVD death, non-fatal MI, non-fatal stroke, hospitalized angina) after nearly 10 years of follow-up. There was a suggestion of heterogeneity of response based on the history of prior CVD at baseline (p=0.06). Despite the overall lack of CVD risk reduction, ILI remains important for care of patients with T2DM, particularly when accompanied by medication management. In particular, ILI may be an appealing option for patients wanting to minimize medication intensification. Also, ILI carries with it other potential benefits important to patients (e.g., improvements in physical functioning and QoL). Based on data from other trials, intensive medication management, such as tight glycemic control, is not without potential risks, which should be weighed in making treatment decisions. Future research is needed to determine if results observed in this trial would be replicated among younger patients, those without established T2DM, and/or those with no pre-existing CVD.

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Section: Implications For Preventive Cardiologymentioning

confidence: 99%

The Look AHEAD Trial: Implications for Lifestyle Intervention in Type 2 Diabetes Mellitus

Dutton

Lewis

2015

Progress in Cardiovascular Diseases

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“…The logistic models for calculating propensity scores included HbA1c, age, gender, race, BMI, insulin use and practice site at the matching (baseline) year as covariates. Matching variables were chosen based upon (1) diabetes control and disease burden (HbA1c, insulin use), (2) demographic and clinical factors that may affect diabetes control or prescribed targets (age, 15,16 gender, 17 race, 18 BMI), and (3) care delivered by the same group of providers(practice site).…”

Section: Discussionmentioning

confidence: 99%

“…The use of standardized treatment goals may also have discouraged participation by those far from the goals. Recent recommendations for diabetes care to be patient-centered, 15 and evidence that tailored behavioral interventions are effective for improving control of diabetes and 32 hypertension 33 and for increasing physical activity, support individualized treatment goals 34 such as a mutually agreed upon HbA1c. In the EHP, weight targets were individualized, which may have facilitated the significant weight reduction we observed among employees with a BMI >27 and contributed to the greater weight reductions among employees over 5 years.…”

Section: Discussionmentioning

confidence: 99%

Financial Incentives and Diabetes Disease Control in Employees: A Retrospective Cohort Analysis

Misra‐Hebert

Taksler

et al. 2016

J GEN INTERN MED

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“…The National Heart Lung and Blood Institute (NHLBI) [32], American Diabetes Association (ADA) [33] and American Heart Association (AHA) [34] each have guidelines for the evaluation and management of dyslipidemia in pediatric patients with diabetes. While the guidelines differ slightly (Table 1), all agree that dyslipidemia should be more aggressively managed in youth with diabetes versus youth without diabetes.…”

Section: Dyslipidemiamentioning

confidence: 99%

“…Recommendations for the treatment of hypertension and prehypertension in youth with T1D differ slightly between ADA guidelines [33] and NHLBI guidelines [32]. NHLBI guidelines distinguish between prehypertension (BP mean that is ≥90 th percentile for age, sex, and height or ≥120/80), Stage 1 Hypertension (defined as mean BP ≥95 th percentile for age, sex, and height but <99 th percentile plus 5 mmHg), and Stage 2 Hypertension (defined as mean BP ≥ 99 th percentile plus 5 mmHg) in order to determine the speed and intensity of the workup as well as treatment strategies.…”

Section: Hypertensionmentioning

confidence: 99%

Challenges and Opportunities in the Management of Cardiovascular Risk Factors in Youth With Type 1 Diabetes: Lifestyle and Beyond

2015

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Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in persons with type 1 diabetes (T1D). Specific risk factors associated with diabetes, such as hyperglycemia and kidney disease, have been demonstrated to increase the incidence and progression of CVD. Nevertheless, few data exist on the effects of traditional risk factors such as dyslipidemia, obesity and hypertension on CVD risk in youth with T1D. Improvements in understanding and approaches to the evaluation and management of CVD risk factors, specifically for young persons with T1D, are desirable. Recent advances in non-invasive techniques to detect early vascular damage, such as the evaluation of endothelial dysfunction and aortic or carotid intima media thickness, provide new tools to evaluate the progression of CVD in childhood. In the present review, current CVD risk factor management, challenges, and potential therapeutic interventions in youth with T1D are described.

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1. Strategies for Improving Care

Cited by 80 publications

References 42 publications

The Look AHEAD Trial: Implications for Lifestyle Intervention in Type 2 Diabetes Mellitus

The Look AHEAD Trial: Implications for Lifestyle Intervention in Type 2 Diabetes Mellitus

Financial Incentives and Diabetes Disease Control in Employees: A Retrospective Cohort Analysis

Challenges and Opportunities in the Management of Cardiovascular Risk Factors in Youth With Type 1 Diabetes: Lifestyle and Beyond

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