For people who are overweight or obese and have type 2 diabetes, the first line of treatment is usually lifestyle intervention, including weight loss and increased physical activity. While this approach has cardiovascular benefits for many, it can be harmful to people with poor blood sugar control, according to a study by researchers at the Wake Forest School of Medicine.
In the study, published in the current issue of Diabetes Care, researchers reassessed the National Institutes of Health Action’s study for health in diabetes (Look AHEAD), which found that intensive lifestyle intervention (ILI) Neither helped nor hurt people with diabetes.
In contrast to the initial Look AHEAD results, our work found that lifestyle interventions reduced potential cardiovascular damage and optimized benefits for 85% of study participants. However, in patients with poor glycemic control, lifestyle intervention increased the risk of serious cardiovascular events. Based on our findings, doctors may want to consider alternative options, such as: B. Medicines to lower glucose before attempting lifestyle changes. “
Michael P. Bancks, Ph.D., study lead researcher, assistant professor of public health science, Wake Forest School of Medicine, part of Wake Forest Baptist Health
Look AHEAD randomized 5145 participants with type 2 diabetes (T2D) who were overweight or obese for 10 years of ILI or a control group who received support and education about diabetes. ILI focused on weight loss through decreased caloric intake and increased physical activity.
In the Wake Forest School of Medicine study, researchers divided study participants into four subgroups: diabetes in old age, poor blood sugar control, severe obesity and younger age in old age. These subgroups were determined based on the diagnosis of diabetes, the body mass index, the waist circumference, the measure for the blood sugar level (blood sugar control) and the age of the onset of diabetes.
Bancks and his team examined each group’s response to the intense lifestyle intervention and its association with major cardiovascular events. In the subgroup with poor glycemic control, the intervention was associated with an 85% higher risk of a cardiovascular event compared to the control group. Among the other three diabetes subgroups studied, ILI was not associated with an increased risk of fatal and non-fatal cardiovascular events.
“While interest in diabetes subgroups is growing, our study is one of the first to apply it to lifestyle interventions,” said Bancks. “For doctors, identifying the subgroup that their patient most closely resembles should help them determine the best treatment option and reduce the potential harm to that person.”
These results aid further investigation into whether these results apply to other diabetes complications, including cognitive problems, and to evaluate which interventions are beneficial for these individuals, Bancks said.
Wake Forest Baptist Medical Center