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Long-term effect of intensive lifestyle intervention on cardiovascular risk factors in patients with diabetes in real-world clinical practice: a 5-year longitudinal study
  1. Osama Hamdy,
  2. Adham Mottalib,
  3. Amr Morsi,
  4. Nuha El-Sayed,
  5. Ann Goebel-Fabbri,
  6. Gillian Arathuzik,
  7. Jacqueline Shahar,
  8. Amanda Kirpitch,
  9. John Zrebiec
  1. Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts, USA
  1. Correspondence to Dr Osama Hamdy; osama.hamdy{at}joslin.harvard.edu

Abstract

Objective We evaluated long-term impact of sustained weight loss versus weight regain on cardiovascular risk factors in real-world clinical practice.

Methods We evaluated 129 obese patients with diabetes enrolled in Weight Achievement and Intensive Treatment (Why WAIT) program, a 12-week clinical model of intensive lifestyle intervention. After 1 year, we divided participants into group A, who maintained <7% weight loss (47.3%) and group B (52.7%), who maintained ≥7% weight loss. We continued to follow them for a total of 5 years.

Results The total cohort lost 23.8 lbs (−9.7%) at 12 weeks and maintained −16.2 lbs (−6.4%) at 5 years (p<0.001). Group A maintained −8.4 lbs (−3.5%) and group B maintained −23.1 lbs (−9.0%) at 5 years. In group A, A1C decreased from 7.5±1.3% to 6.7±0.9% at 12 weeks but increased to 7.7±1.4% at 1 year and 8.0±1.9% at 5 years. In group B, A1C decreased from 7.4±1.2% to 6.4±0.9% at 12 weeks and rose to 6.8±1.2% at 1 year and 7.3±1.5% at 5 years. Despite weight regain, group A maintained improvement in low-density lipoprotein-cholesterol and high-density lipoprotein-cholesterol with worsening of serum triglycerides and no change in blood pressure (BP). Group B maintained improvement in lipid profile for 5 years and had significantly lower BP for 18 months.

Conclusions Weight reduction in patients with diabetes can be maintained for 5 years and is predicted by patients’ ability to maintain ≥7% weight loss at 1 year. A1C and triglycerides deteriorate with weight regain, while other lipid improvements are maintained. Sustained weight loss is associated with significantly lower A1C for 5 years and lowers BP for 18 months.

Trial registration number NCT01937845.

  • Weight Management
  • Lifestyle Intervention(s)
  • Cardiovascular Disease Risk

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Contributors OH and AM have full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. OH directs the Why WAIT program, designed the medication algorithm used in the study, prepared the manuscript and did the data analysis. AdM collected study data and reviewed and edited the manuscript. AmM collected study data and measured the body composition. AG-F designed and conducted the behavioral intervention portion of the program and reviewed and edited the manuscript. NE-S reviewed and edited the manuscript. GA designed the dietary intervention and with AK conducted the dietary counseling and intervention. JS designed and conducted the exercise intervention. JZ conducted the behavioral intervention, reviewed and edited the manuscript.

  • Competing interests OH receives research support from Neurometrix and Metagenics and consults to Merck Pharmaceutical and Abbott Nutrition. None of the authors’ financial interests are related or influenced this study. Other authors do not have any competing interests to disclose.

  • Ethics approval The Joslin Diabetes Center, Committee on Human Studies.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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