Lifestyle Change and Mobility in Obese Adults With Type 2 Diabetes

Study Questions:

Adults with type 2 diabetes mellitus often have limitations in mobility that increase with age. What is the effect of an intensive lifestyle intervention that produces weight loss and improves fitness on loss of mobility in diabetics?

Methods:

The study group randomly assigned 5,145 overweight or obese adults between the ages of 45 and 74 years with type 2 diabetes to either an intensive lifestyle intervention or a diabetes support-and-education program; 5,016 participants contributed data. A hidden Markov model was used to characterize disability states and mixed-effects ordinal logistic regression to estimate the probability of functional decline. The primary outcome was self-reported limitation in mobility, with annual assessments for 4 years.

Results:

Mean age was ~59 years; 60% were female, 15% Black, and 13% Hispanic. Entry glycated hemoglobin was 7.3% with 75% on oral hypoglycemics and 19% on insulin. At year 4, among adults in the lifestyle-intervention group, 20.6% had severe disability and 38.5% had good mobility, whereas participants in the support group were 26.2% and 31.9%, respectively. The lifestyle-intervention group had a relative reduction of 48% in the risk of loss of mobility, as compared with the support group (odds ratio, 0.52; 95% confidence interval, 0.44-0.63; p < 0.001). Both weight loss and improved fitness (as assessed on treadmill testing) were significant mediators of this effect (p < 0.001 for both variables). Adverse events that were related to the lifestyle intervention included a slightly higher frequency of musculoskeletal symptoms at year 1.

Conclusions:

Weight loss and improved fitness slowed the decline in mobility in overweight adults with type 2 diabetes.

Perspective:

The Look AHEAD (Action for Health in Diabetes) study was designed to determine whether intentional weight loss (7%) with caloric restriction and exercise (>175 minutes/week) would reduce morbidity and mortality from cardiovascular causes. It was projected that it would require an 11.5-year follow-up based on a 0.90 probability of detecting an 18% difference in major cardiovascular disease event rates between the two groups. Other outcomes include components of cardiovascular disease risk, cost and cost-effectiveness, diabetes control and complications, hospitalizations, intervention processes, and quality of life. This is obviously a very important study for diabetics, their families, and society.

Clinical Topics: Prevention, Diet

Keywords: Odds Ratio, Insulin, Life Style, Weight Loss, Diabetes Mellitus, Type 2, Hispanic Americans, Caloric Restriction, Hemoglobins, Cardiovascular Diseases, Obesity, Hypoglycemic Agents, Confidence Intervals, Hospitalization, Logistic Models


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