Reduction in the Incidence of Type 2 Diabetes with Lifestyle Intervention or Metformin

Knowler, William C.; Barrett‐Connor, Elizabeth; Fowler, Sarah E.; Hamman, Richard F.; Lachin, John M.; Walker, Elizabeth A.; Nathan, David M.

doi:10.1056/nejmoa012512

Cited by 15,373 publications

(5,215 citation statements)

References 25 publications

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“…The Diabetes Prevention Program (DPP), e.g. lifestyle intervention, reduced the risk of developing diabetes by 58% compared with a placebo intervention 3. In Look AHEAD, intensive lifestyle intervention (ILI) did not reduce cardiovascular morbidity and mortality in persons who were overweight or obese with type 2 diabetes 4, but it produced improvements in sleep apnea, incontinence and erectile dysfunction, reduced the incidence of high‐risk kidney disease and resulted in better long‐term diabetes control and some remission of diabetes, as well as fewer hospitalizations, compared with the control group 5, 6, 7, 8, 9, 10.…”

Section: Introductionmentioning

confidence: 99%

Cost of intervention delivery in a lifestyle weight loss trial in type 2 diabetes: results from the Look AHEAD clinical trial

Rushing

Wing

Wadden

et al. 2017

Obesity Science & Practice

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SummaryObjectiveThe Action for Health in Diabetes (Look AHEAD) trial was a randomized controlled clinical trial to compare the effects of 10 years of intensive lifestyle intervention (ILI) with a control condition of diabetes support and education (DSE) on health outcomes in over 5,000 participants with type 2 diabetes. The ILI had significantly greater weight losses than DSE throughout the trial. The goal of this analysis is to describe the cost of delivering the intervention.MethodsThe ILI was designed to promote weight loss and increase physical activity. It involved a combination of group plus individual intervention sessions, with decreasing frequency of contact over the 10 years. The intervention incorporated a variety of strategies, including meal replacement products, to improve weight loss outcomes. The costs of intervention delivery were derived from staff surveys of effort and from records of intervention materials from the 16 US academic clinical trial sites. Costs were calculated from the payer perspective and presented in 2012 dollars.ResultsDuring the first year, when intervention delivery was most intensive, the annual cost of intervention delivery, averaged (standard deviation) across clinical sites, was $2,864.6 ($513.3) per ILI participant compared with $202.4 ($76.6) per DSE participant. As intervention intensity declined, costs decreased, such that from years 5 to 9 of the trial, the annual cost of intervention was $1,119.8 ($227.7) per ILI participant and $102.9 ($33.0) per DSE participant. Staffing accounted for the majority of costs throughout the trial, with meal replacements and materials to promote adherence accounting for smaller shares.ConclusionsThe sustained weight losses produced by the Look AHEAD intervention were supported by intervention costs that were within the range of other weight loss programmes. Future work will include an evaluation of the cost‐effectiveness of the ILI and will contain additional follow‐up data.

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Section: Introductionmentioning

confidence: 99%

Cost of intervention delivery in a lifestyle weight loss trial in type 2 diabetes: results from the Look AHEAD clinical trial

Rushing

Wing

Wadden

et al. 2017

Obesity Science & Practice

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“…After 2.8 years, participants assigned to the lifestyle intervention group had shown a greater increase in physical activity and greater weight loss (−5.6 kg) than those on metformin (−2.1 kg) or placebo (−0.1 kg) ( P < 0.001 for both) 63. Compared with placebo, lifestyle intervention and treatment with metformin had reduced the incidence of type 2 diabetes by, respectively, 58% and 31% 63, and had reduced the incidence of metabolic syndrome by 41% and 17% 64. These findings demonstrate that intense lifestyle intervention can be effective in long‐term weight loss, weight maintenance and in risk associated with comorbidities.…”

Section: Lifestyle Modification and Weight Maintenancementioning

confidence: 99%

“…Half of the lifestyle intervention group achieved the 7% weight reduction goal after 24 weeks 63. After 2.8 years, participants assigned to the lifestyle intervention group had shown a greater increase in physical activity and greater weight loss (−5.6 kg) than those on metformin (−2.1 kg) or placebo (−0.1 kg) ( P < 0.001 for both) 63. Compared with placebo, lifestyle intervention and treatment with metformin had reduced the incidence of type 2 diabetes by, respectively, 58% and 31% 63, and had reduced the incidence of metabolic syndrome by 41% and 17% 64.…”

Section: Lifestyle Modification and Weight Maintenancementioning

confidence: 99%

“…Participants were randomized into three groups as follows: (i) the lifestyle intervention group received intensive training in diet, physical activity and behaviour modification (24‐week curriculum), with the aim of losing ≥7% of their body weight and maintaining that weight loss; (ii) a second group received 850 mg of metformin twice daily, and (iii) a third group received placebo 44, 63. The metformin and placebo groups both received information on diet and exercise but received no intensive or individualized counselling 63. Half of the lifestyle intervention group achieved the 7% weight reduction goal after 24 weeks 63.…”

Section: Lifestyle Modification and Weight Maintenancementioning

confidence: 99%

“…The metformin and placebo groups both received information on diet and exercise but received no intensive or individualized counselling 63. Half of the lifestyle intervention group achieved the 7% weight reduction goal after 24 weeks 63. After 2.8 years, participants assigned to the lifestyle intervention group had shown a greater increase in physical activity and greater weight loss (−5.6 kg) than those on metformin (−2.1 kg) or placebo (−0.1 kg) ( P < 0.001 for both) 63.…”

Section: Lifestyle Modification and Weight Maintenancementioning

confidence: 99%

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Weight maintenance: challenges, tools and strategies for primary care physicians

2015

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SummaryObesity is recognized as a chronic disease and one of the major healthcare challenges facing us today. Weight loss can be achieved via lifestyle, pharmacological and surgical interventions, but weight maintenance remains a lifetime challenge for individuals with obesity. Guidelines for the management of obesity have highlighted the role of primary care providers (PCPs). This review examines the long‐term outcomes of clinical trials to identify effective weight maintenance strategies that can be utilized by PCPs. Because of the broad nature of the topic, a structured PubMed search was conducted to identify relevant research articles, peer‐reviewed reviews, guidelines and articles published by regulatory bodies. Trials have demonstrated the benefit of sustained weight loss in managing obesity and its comorbidities. Maintaining 5–10% weight loss for ≥1 year is known to ameliorate many comorbidities. Weight maintenance with lifestyle modification – although challenging – is possible but requires long‐term support to reinforce diet, physical activity and behavioural changes. The addition of pharmacotherapy to lifestyle interventions promotes greater and more sustained weight loss. Clinical evidence and recently approved pharmacotherapy has given PCPs improved strategies to support their patients with maintenance of weight loss. Further studies are needed to assess the translation of these strategies into clinical practice.

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Exercise Dose and Diabetes Risk in Overweight and Obese Children

Davis¹,

Pollock²,

Waller³

et al. 2012

JAMA

183

195

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Reduction in the Incidence of Type 2 Diabetes with Lifestyle Intervention or Metformin

Abstract: Lifestyle changes and treatment with metformin both reduced the incidence of diabetes in persons at high risk. The lifestyle intervention was more effective than metformin.

Cited by 15,373 publications

References 25 publications

Cost of intervention delivery in a lifestyle weight loss trial in type 2 diabetes: results from the Look AHEAD clinical trial

Cost of intervention delivery in a lifestyle weight loss trial in type 2 diabetes: results from the Look AHEAD clinical trial

Weight maintenance: challenges, tools and strategies for primary care physicians

Exercise Dose and Diabetes Risk in Overweight and Obese Children

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