3.2.0.0 Look AHEAD Trial
Although the Action for Health in Diabetes (Look AHEAD) trial did not show that an intensive lifestyle intervention reduced cardiovascular events in adults with type 2 diabetes who were overweight or obese (26), it did show the feasibility of achieving and maintaining long-term weight loss in patients with type 2 diabetes. In the Look AHEAD intensive lifestyle intervention group, mean weight loss was 4.7% at 8 years (27). Approximately 50% of intensive lifestyle intervention participants lost and maintained ≥5% and 27% lost and maintained ≥10% of their initial body weight at 8 years (27). Participants randomly assigned to the intensive lifestyle group achieved equivalent risk factor control but required fewer glucose-, blood pressure–, and lipid-lowering medications than those randomly assigned to standard care. Secondary analyses of the Look AHEAD trial and other large cardiovascular outcome studies document other benefits of weight loss in patients with type 2 diabetes, including improvements in mobility, physical and sexual function, and health-related quality of life (28). A post hoc analysis of the Look AHEAD study suggests that heterogeneous treatment effects may have been present. Participants who had moderately or poorly controlled diabetes (A1C ≥6.8% [51 mmol/mol]) as well as both those with well-controlled diabetes (A1C <6.8% [51 mmol/mol]) and good self-reported health were found to have significantly reduced cardiovascular events with intensive lifestyle intervention during follow-up (29).