Effect of an Intensive Lifestyle Intervention on Glycemic Control in Patients With Type 2 Diabetes

Johansen, Mette Yun; MacDonald, Christopher J.; Hansen, Katrine Bagge; Karstoft, Kristian; Christensen, Robin; Pedersen, Maria; Hansen, L.; Zacho, Morten; Wedell‐Neergaard, Anne‐Sophie; Nielsen, Signe Tellerup; Iepsen, Ulrik Winning; Langberg, Henning; Vaag, Allan; Pedersen, Bente Klarlund; Ried‐Larsen, Mathias

doi:10.1001/jama.2017.10169

Cited by 174 publications

(177 citation statements)

References 36 publications

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“…Weight loss was greater in a subgroup of participants who attended all scheduled clinic visits with the study dietitian compared with participants who missed sessions. The benefits of behavioral support, 21 specifically support provided by a dietitian, 22 as well as the effects of lifestyle interventions, 23 are noted in the literature. There was a significant difference in loss of total fat-free mass, which was greater in the intermittent energy restriction group for completers.…”

Section: Discussionmentioning

confidence: 99%

Effect of Intermittent Compared With Continuous Energy Restricted Diet on Glycemic Control in Patients With Type 2 Diabetes

2018

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Importance Intermittent energy restriction is an alternative weight loss method that is becoming popular; however, to date, there are no long-term clinical trials of intermittent energy restriction in patients with type 2 diabetes. Objective To compare the effects of intermittent energy restriction (2 days per week) with those of continuous energy restriction on glycemic control and weight loss in patients with type 2 diabetes during a 12-month period. Design, Setting, and Participants Adult participants (N = 137) with type 2 diabetes were randomized 1:1 to parallel diet groups (intermittent energy restriction [n = 70] or continuous energy restriction [n = 67]) between April 7, 2015, and September 7, 2017, at the University of South Australia. Medications likely to cause hypoglycemia were reduced at baseline according to the medication management protocol. Interventions An intermittent energy restriction diet (500-600 kcal/d) followed for 2 nonconsecutive days per week (participants followed their usual diet for the other 5 days) or a continuous energy restriction diet (1200-1500 kcal/d) followed for 7 days per week for 12 months. Main Outcomes and Measures The primary outcome was change in hemoglobin A 1c (HbA 1c ) level, with equivalence prespecified by a 90% CI margin of ±0.5%. The secondary outcome was weight loss with equivalence set at ±2.5 kg (±1.75 kg for fat mass loss and ±0.75 kg for fat-free mass loss). All other outcomes were tested for superiority. Results Of the 137 randomized participants (77 women and 60 men; mean [SD] age, 61.0 [9.1] years; mean [SD] body mass index, 36.0 [5.8] [calculated as weight in kilograms divided by height in meters squared]; and mean [SD] HbA 1c level, 7.3% [1.3%]), 97 completed the trial. Intention-to-treat analysis showed similar reductions in mean (SEM) HbA 1c level between the continuous and intermittent energy restriction groups (–0.5% [0.2%] vs –0.3% [0.1%]; P = .65), with a between-group difference of 0.2% (90% CI, –0.2% to 0.5%) meeting the criteria for equivalence. Mean (SEM) weight change was similar between the continuous and intermittent energy restriction groups (–5.0 [0.8] kg vs –6.8 [0.8] kg; P = .25), but the between-group difference did not meet the criteria for equivalence (–1.8 kg; 90% CI, –3.7 to 0.07 kg), nor did the between-group difference in fat mass (–1.3 kg; 90% CI, –2.8 to 0.2 kg) or fat-free mass (–0.5 kg; 90% CI, –1.4 to 0.4 kg). There were no significant differences between groups in final step count, fasting glucose levels, lipid levels, or total medication effect score at 12 months. Effects did not differ using completers analysis. Hypoglycemic or hyperglycemic events in the first 2 weeks of treatment were similar between t...

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Section: Discussionmentioning

confidence: 99%

Effect of Intermittent Compared With Continuous Energy Restricted Diet on Glycemic Control in Patients With Type 2 Diabetes

2018

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“…Although there is evidence supporting the benefits of CT for improving glucose control in T2DM patients, there is yet no clear indication of the ability of this exercise modality to combat T2DM‐associated comorbidities as the metabolic syndrome markers. A 12‐month lifestyle intervention for T2DM patients that included exercise training (5‐6 ET sessions of 30‐60 minutes duration plus 2‐3 RT sessions per week) and diet decreased fasting glucose (−7.8 mg/dL on average) and changed several other parameters, such as abdominal fat (−0.81 kg), lean mass (+0.62 kg), SBP/DBP (−1.5/−1.4 mm Hg), triglycerides (−8.4 mg/dL), and VO 2peak (+14.5%). Along this line, after an 8‐week CT intervention for T2DM patients (60 minutes/session, including ET (cycling/treadmill) plus RT at 55%‐85% of 1RM), Maiorana et al found decreases in fasting glucose (−40 mg/dL on average), resting heart rate (−4 beats/min), waist‐to‐hip ratio (−1.3%), and fat mass (−0.8%), but no changes in lipid profile or blood pressure .…”

Section: Discussionmentioning

confidence: 99%

Concurrent exercise training on hyperglycemia and comorbidities associated: Non‐responders using clinical cutoff points

Álvarez

Ramírez‐Campillo

Lucía

et al. 2019

Scandinavian Med Sci Sports

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This study examined the effects of a 20‐week concurrent training (CT, ie, resistance plus endurance training) intervention on cardiovascular risk factors, such as body composition, blood pressure, and lipid profile among adult women with hyperglycemia. A secondary aim was to report prevalence of non‐responders for the different study outcomes. Physically inactive overweight/obese and hyperglycemic adult women (42 ± 6 years; BMI = 30.9 ± 4.8 kg/m2) were randomly assigned to a 20‐week CT intervention group or a control (non‐exercise) group (CG) (n = 14/group). Cardiovascular risk factors for body composition (body mass, waist circumference [WC], fat mass, and lean mass), blood pressure, and lipid profile (total, LDL cholesterol and HDL cholesterol, triglycerides, and fasting glucose) were assessed before and after the 20‐week intervention. Our results show that a CT intervention results in a reduction of comorbidities in terms of abdominal obesity and cardiovascular risk in adult women with hyperglycemia by decreasing WC and improving lipid profile in “mean” terms. At the individual level, after CT, some subjects changed their status from a “high” to a “low” cardiovascular risk in terms of WC, while others changed from hypertension to either high blood pressure or normotension, or from high blood pressure to normotension, and others changed from hypercholesterolemia/dyslipidemia to normocholesterolemia. Overall, there were ~30%, 50%, and 20% of individuals in the CT exercise group who showed no change/adverse response for body composition, blood pressure, and lipid profile, respectively, after the 20‐week CT intervention.

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“…The present extension study was designed as a pragmatic superiority study based on follow‐up assessment of the participants in a recent single‐centre clinical trial (Appendix S1), conducted in the Capital Region of Denmark from 29 April 2015 to 17 August 2017 and including 98 participants. The primary outcome was assessed after a 12‐month intervention and published previously . The data for the present extension study were based on the follow‐up examinations 12 months after the primary outcome assessment (ie, 24 months from the baseline assessments).…”

Section: Methodsmentioning

confidence: 99%

Type 2 diabetes remission 1 year after an intensive lifestyle intervention: A secondary analysis of a randomized clinical trial

Ried‐Larsen

Johansen

MacDonald

et al. 2019

Diabetes Obesity Metabolism

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Aim To investigate whether an intensive lifestyle intervention induces partial or complete type 2 diabetes (T2D) remission. Materials and methods In a secondary analysis of a randomized, assessor‐blinded, single‐centre trial, people with non‐insulin‐dependent T2D (duration <10 years), were randomly assigned (2:1, stratified by sex, from April 2015 to August 2016) to a lifestyle intervention group (n = 64) or a standard care group (n = 34). The primary outcome was partial or complete T2D remission, defined as non‐diabetic glycaemia with no glucose‐lowering medication at the outcome assessments at both 12 and 24 months from baseline. All participants received standard care, with standardized, blinded, target‐driven medical therapy during the initial 12 months. The lifestyle intervention included 5‐ to 6‐weekly aerobic and combined aerobic and strength training sessions (30‐60 minutes) and individual dietary plans aiming for body mass index ≤25 kg/m2. No intervention was provided during the 12‐month follow‐up period. Results Of the 98 randomized participants, 93 completed follow‐up (mean [SD] age 54.6 [8.9] years; 46 women [43%], mean [SD] baseline glycated haemoglobin 49.3 [9.3] mmol/mol). At follow‐up, 23% of participants (n = 14) in the intervention and 7% (n = 2) in the standard care group met the criteria for any T2D remission (odds ratio [OR] 4.4, 95% confidence interval [CI] 0.8‐21.4]; P = 0.08). Assuming participants lost to follow‐up (n = 5) had relapsed, the OR for T2D remission was 4.4 (95% CI 1.0–19.8; P = 0.048). Conclusions The statistically nonsignificant threefold increased remission rate of T2D in the lifestyle intervention group calls for further large‐scale studies to understand how to implement sustainable lifestyle interventions among people with T2D.

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Effect of an Intensive Lifestyle Intervention on Glycemic Control in Patients With Type 2 Diabetes

Cited by 174 publications

References 36 publications

Effect of Intermittent Compared With Continuous Energy Restricted Diet on Glycemic Control in Patients With Type 2 Diabetes

Effect of Intermittent Compared With Continuous Energy Restricted Diet on Glycemic Control in Patients With Type 2 Diabetes

Concurrent exercise training on hyperglycemia and comorbidities associated: Non‐responders using clinical cutoff points

Type 2 diabetes remission 1 year after an intensive lifestyle intervention: A secondary analysis of a randomized clinical trial

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