Association of an intensive lifestyle intervention with remission of type 2 diabetes.
Edward W. Gregg,Haiying Chen,Lynne E. Wagenknecht,Jeanne M. Clark,Linda M. Delahanty,John P. Bantle,Henry J. Pownall,Karen C. Johnson,Monika M. Safford,Abbas E. Kitabchi,F. Xavier Pi-Sunyer,Rena R. Wing,Alain G. Bertoni +12 more
TLDR
In these exploratory analyses of overweight adults, an intensive lifestyle intervention was associated with a greater likelihood of partial remission of type 2 diabetes compared with diabetes support and education, however, the absolute remission rates were modest.Abstract:
Context The frequency of remission of type 2 diabetes achievable with lifestyle intervention is unclear. Objective To examine the association of a long-term intensive weight-loss intervention with the frequency of remission from type 2 diabetes to prediabetes or normoglycemia. Design, Setting, and Participants Ancillary observational analysis of a 4-year randomized controlled trial (baseline visit, August 2001–April 2004; last follow-up, April 2008) comparing an intensive lifestyle intervention (ILI) with a diabetes support and education control condition (DSE) among 4503 US adults with body mass index of 25 or higher and type 2 diabetes. Interventions Participants were randomly assigned to receive the ILI, which included weekly group and individual counseling in the first 6 months followed by 3 sessions per month for the second 6 months and twice-monthly contact and regular refresher group series and campaigns in years 2 to 4 (n=2241) or the DSE, which was an offer of 3 group sessions per year on diet, physical activity, and social support (n=2262). Main Outcome Measures Partial or complete remission of diabetes, defined as transition from meeting diabetes criteria to a prediabetes or nondiabetic level of glycemia (fasting plasma glucose 1c Results Intensive lifestyle intervention participants lost significantly more weight than DSE participants at year 1 (net difference, −7.9%; 95% CI, −8.3% to −7.6%) and at year 4 (−3.9%; 95% CI, −4.4% to −3.5%) and had greater fitness increases at year 1 (net difference, 15.4%; 95% CI, 13.7%-17.0%) and at year 4 (6.4%; 95% CI, 4.7%-8.1%) (P Conclusions In these exploratory analyses of overweight adults, an intensive lifestyle intervention was associated with a greater likelihood of partial remission of type 2 diabetes compared with diabetes support and education. However, the absolute remission rates were modest. Trial Registration clinicaltrials.gov Identifier: NCT00017953read more
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Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes.
Rena R. Wing,Paula Bolin,Frederick L. Brancati,George A. Bray,Jeanne M. Clark,Mace Coday,Richard S. Crow,Jeffrey M. Curtis,Caitlin Egan,Mark A. Espeland,Mary Evans,John P. Foreyt,Siran Ghazarian,Edward W. Gregg,Barbara Harrison,Helen P. Hazuda,James O. Hill,Edward S. Horton,S. Van Hubbard,John M. Jakicic,Robert W. Jeffery,Karen C. Johnson,Steven E. Kahn,Abbas E. Kitabchi,William C. Knowler,Cora E. Lewis,Barbara J. Maschak-Carey,Maria G. Montez,Anne Murillo,David M. Nathan,Jennifer Patricio,Anne L. Peters,Xavier Pi-Sunyer,Henry J. Pownall,David M. Reboussin,Judith G. Regensteiner,Amy D. Rickman,Donna H. Ryan,Monika M. Safford,Thomas A. Wadden,Lynne E. Wagenknecht,Delia Smith West,David F. Williamson,Susan Z. Yanovski +43 more
TL;DR: An intensive lifestyle intervention focusing on weight loss did not reduce the rate of cardiovascular events in overweight or obese adults with type 2 diabetes.
Journal ArticleDOI
Pathophysiology and treatment of type 2 diabetes: perspectives on the past, present, and future
TL;DR: More effective therapies to slow progressive loss of β-cell function are needed and additional long-term studies of drugs and bariatric surgery are needed to identify new ways to prevent and treat type 2 diabetes and thereby reduce the harmful effects of this disease.
Journal ArticleDOI
Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial
Michael E. J. Lean,Wilma S Leslie,Alison C. Barnes,Naomi Brosnahan,George Thom,Louise McCombie,Carl Peters,Sviatlana Zhyzhneuskaya,Ahmad Al-Mrabeh,Kieren G. Hollingsworth,Angela M. Rodrigues,Lucia Rehackova,Ashley J. Adamson,Falko F. Sniehotta,John C. Mathers,H. M. Ross,Yvonne McIlvenna,Renae J. Stefanetti,Michael I. Trenell,Paul Welsh,Sharon Kean,Ian Ford,Alex McConnachie,Naveed Sattar,Roy Taylor +24 more
TL;DR: The findings show that, at 12 months, almost half of participants achieved remission to a non-diabetic state and off antidiabetic medications, from baseline to 12 months.
Journal ArticleDOI
American association of clinical endocrinologists and american college of endocrinology comprehensive clinical practice guidelines for medical care of patients with obesity.
W. Timothy Garvey,Jeffrey I. Mechanick,Elise M. Brett,Alan J. Garber,Daniel L. Hurley,Ania M. Jastreboff,Karl Nadolsky,Rachel Pessah-Pollack,Raymond A Plodkowski +8 more
TL;DR: The final recommendations recognize that obesity is a complex, adiposity-based chronic disease, where management targets both weight-related complications and adiposity to improve overall health and quality of life.
Journal ArticleDOI
Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes.
TL;DR: The results from this trial suggest that intensive lifestyle interventions are effective in helping patients to achieve management of cardiovascular risk factors and reducing the need to initiate medication usage to manage these conditions, though the benefits in terms of the prevention of CVD morbidity and mortality beyond those achieved through aggressive medical management of hypertension and dyslipidemia is not clear.
References
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William C. Knowler,Elizabeth Barrett-Connor,Sarah E. Fowler,Richard F. Hamman,John M. Lachin,Elizabeth A. Walker,David M. Nathan +6 more
TL;DR: In this paper, the authors compared a lifestyle intervention with metformin to prevent or delay the development of Type 2 diabetes in nondiabetic individuals. And they found that the lifestyle intervention was significantly more effective than the medication.
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TL;DR: Type 2 diabetes can be prevented by changes in the lifestyles of high-risk subjects by means of individualized counseling aimed at reducing weight, total intake of fat, and intake of saturated fat and increasing intake of fiber and physical activity.
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Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38
M R Stearne,S L Palmer,M S Hammersley,S L Franklin,R S Spivey,Jonathan C. Levy,C R Tidy,N J Bell,J Steemson,B A Barrow,R Coster,K Waring,J Nolan,E Truscott,N Walravens,L Cook,H Lampard,C Merle,P Parker,J McVittie,I Draisey,L E Murchison,A H E Brunt,M J Williams,D W Pearson,X M P Petrie,M E J Lean,D Walmsley,M J Lyall,E Christie,J Church,E Thomson,A Farrow,J M Stowers,M Stowers,K McHardy,N Patterson,Alex D. Wright,N A Levi,A C I Shearer,R J W Thompson,G Taylor,S Rayton,M Bradbury,A Glover,A Smyth-Osbourne,C Parkes,J Graham,P England,S Gyde,C Eagle,B Chakrabarti,Josh Smith,J Sherwell,E M Kohner,A Dornhurst,M C Doddridge,M Dumskyj,S Walji,P Sharp,M Sleightholm,G Vanterpool,C Rose,G Frost,M Roseblade,S Elliott,S Forrester,Meredith C. Foster,K Myers,R Chapman,J R Hayes,R W Henry,M S Featherston,G P R Archbold,M Copeland,R Harper,I Richardson,S Martin,H A Davison,D R Hadden,L Kennedy,A B Atkinson,A M Culbert,C Hegan,H Tennet,N Webb,I Robinson,J Holmes,P M Bell,D R McCance,J Rutherford,S Nesbitt,A S Spathis,S Hyer,M E Nanson,L M James,J M Tyrell,C Davis,P Strugnell,M Booth,H Petrie,D Clark,B Rice,S Hulland,J L Barron,J S Yudkin,B J Gould,J Singer,A Badenock,M Eckert,K Alibhai,E Marriot,Christopher E. Cox,R Price,M Fernandez,A Ryle,S Clarke,G Wallace,E Mehmed,S MacFarlane,R H Greenwood,J Wilson,M J Denholm,R C Temple,K Whitfield,F Johnson,C Munroe,S Gorick,E Duckworth,M Flatman,S Rainbow,L J Borthwick,D J Wheatcroft,R J Seaman,R A Christie,W Wheatcroft,P Musk,Jennifer White,S McDougal,M Bond,P Raniga,R W Newton,R T Jung,C Roxburgh,B Kilgallon,L Dick,N Waugh,S Kilby,A Ellingford,J Burns,C Fox,M C Holloway,H M Coghill,N Hein,A J Fox,W Cowan,M Richard,K Quested,S J Evans,Richard B Paisey,N P R Brown,A J Tucker,R Paisey,F Garrett,J Hogg,P Park,K Williams,P Harvey,R Wilcocks,S Mason,J. C. Frost,C Warren,P Rocket,L Bower,J M Roland,D J Brown,J Youens,K Stanton-King,H Mungall,W Maddison,D Donnelly,S King,P Griffin,Sidney C. Smith,S Church,Graham Dunn,Andrew D. Wilson,K Palmer,P M Brown,D Humphriss,A J M Davidson,Richard Rose,L Armistead,S Townsend,P Poon,I D A Peacock,N J C Culverwell,M H Charlton,B P S Connolly,J Peacock,J Barrett,J Wain,W Beeston,George L. King,P G Hill,Andrew J.M. Boulton,A M Robertson,Katoulis,A Olukoga,H McDonald,S Kumar,F Abouaesha,B Abuaisha,E A Knowles,S Higgins,J Booker,J Sunter,K Breislin,R Parker,P Raval,J Curwell,H Davenport,G Shawcross,A Prest,J Grey,H Cole,C Sereviratne,R J Young,Tim Dornan,J R Clyne,M Gibson,I O'Connell,L M Wong,S J Wilson,K L Wright,Chris Wallace,D McDowell,A C Burden,E M Sellen,R Gregory,M Roshan,N Vaghela,M Burden,C Sherriff,J Clarke,J Grenfell,Je Tooke,K. M. MacLeod,C Searnark,M Rammell,C Pym,J Stockman,C Yeo,J Piper,L Leighton,Ellen Green,M Hoyle,K Jones,A Hudson,A J James,Angela C. Shore,A Higham,B Martin +262 more
TL;DR: Tight blood pressure control in patients with hypertension and type 2 diabetes achieves a clinically important reduction in the risk of deaths related to diabetes, complications related to Diabetes, progression of diabetic retinopathy, and deterioration in visual acuity.
Journal ArticleDOI
Global and societal implications of the diabetes epidemic
TL;DR: The prevention of diabetes and control of its micro- and macrovascular complications will require an integrated, international approach if the authors are to see significant reduction in the huge premature morbidity and mortality it causes.
Journal ArticleDOI
Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. UK Prospective Diabetes Study Group.
Stearne,S L Palmer,Hammersley,S L Franklin,R S Spivey,Jonathan C. Levy,C R Tidy,N J Bell,J Steemson,B A Barrow,R Coster,K Waring,J Nolan,E Truscott,N Walravens,L Cook,H Lampard,C Merle,P Parker,J McVittie,I Draisey,L E Murchison,A H E Brunt,M J Williams,D W Pearson,X M P Petrie,M E J Lean,D Walmsley,M J Lyall,E Christie,J Church,E Thomson,A Farrow,J M Stowers,M Stowers,K McHardy,N Patterson,Alex D. Wright,N A Levi,Aci Shearer,R J W Thompson,G Taylor,S Rayton,M Bradbury,A Glover,A Smyth-Osbourne,C Parkes,J Graham,P England,S Gyde,C Eagle,B Chakrabarti,Josh Smith,J Sherwell,E M Kohner,A Dornhurst,M C Doddridge,M Dumskyj,S Walji,P Sharp,M Sleightholm,G Vanterpool,C Rose,G Frost,M Roseblade,S Elliott,S Forrester,Meredith C. Foster,K Myers,R Chapman,Hayes,R W Henry,Featherston,Gpr Archbold,M Copeland,R Harper,I Richardson,S Martin,H A Davison,Hadden,L Kennedy,A B Atkinson,A M Culbert,C Hegan,H Tennet,N Webb,I Robinson,J Holmes,P M Bell,McCance,J Rutherford,S Nesbitt,A S Spathis,S Hyer,M E Nanson,L M James,J M Tyrell,C Davis,P Strugnell,M Booth,H Petrie,D Clark,B Rice,S Hulland,J L Barron,J S Yudkin,B J Gould,J Singer,A Badenock,M Eckert,K Alibhai,E Marriot,Christopher E. Cox,R Price,M Fernandez,A Ryle,S Clarke,G Wallace,E Mehmed,S MacFarlane,R H Greenwood,James G. Wilson,M J Denholm,R C Temple,K Whitfield,F Johnson,C Munroe,S Gorick,E Duckworth,M Flatman,S Rainbow,L J Borthwick,D J Wheatcroft,R J Seaman,R A Christie,W Wheatcroft,P Musk,Jennifer White,S McDougal,M Bond,P Raniga,R W Newton,R T Jung,C Roxburgh,B Kilgallon,L Dick,N Waugh,S Kilby,A Ellingford,J Burns,C Fox,M C Holloway,H M Coghill,N Hein,A J Fox,W Cowan,M Richard,K Quested,S J Evans,Richard B Paisey,N P R Brown,A J Tucker,R Paisey,F Garrett,J Hogg,P Park,K Williams,P Harvey,R Wilcocks,S Mason,J. C. Frost,C Warren,P Rocket,L Bower,J M Roland,D J Brown,J Youens,K Stanton-King,H Mungall,W Maddison,D Donnelly,S King,P Griffin,Sidney C. Smith,S Church,Graham Dunn,Andrew D. Wilson,K Palmer,P M Brown,D Humphriss,A J M Davidson,Richard Rose,L Armistead,S Townsend,P Poon,I D A Peacock,N J C Culverwell,M H Charlton,B P S Connolly,J Peacock,J Barrett,J Wain,W Beeston,George L. King,P G Hill,A J M Boulton,A M Robertson,Katoulis,A Olukoga,H McDonald,S Kumar,F Abouaesha,B Abuaisha,E A Knowles,S Higgins,J Booker,J Sunter,K Breislin,R Parker,P Raval,J Curwell,H Davenport,G Shawcross,A Prest,J Grey,H Cole,C Sereviratne,R J Young,Tim Dornan,Clyne,M Gibson,I O'Connell,L M Wong,S J Wilson,K L Wright,Chris Wallace,D McDowell,A C Burden,E M Sellen,R Gregory,M Roshan,N Vaghela,M Burden,C Sherriff,J Clarke,J Grenfell,Je Tooke,K. M. MacLeod,C Searnark,M Rammell,C Pym,J Stockman,C Yeo,J Piper,L Leighton,Ellen Green,M Hoyle,K Jones,A Hudson,A J James,Angela C. Shore,A Higham,B Martin,Uspds Grp +263 more
TL;DR: In this article, the authors compared tight control of blood pressure with less tight control aiming at a blood pressure of <150/85 mm Hg with the use of an angiotensin converting enzyme inhibitor captopril or a beta blocker atenolol as main treatment.
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