Adherence
Intensive lifestyle intervention for weight loss in type 2 diabetes does not significantly reduce the primary composite cardiovascular endpoint (death from CV causes, nonfatal MI, nonfatal stroke, or hospitalization for angina) compared to diabetes support and education.
For people with type 2 diabetes, intensive lifestyle changes (diet and exercise) aiming for modest weight loss (7%) and activity (175 mins/week) did not statistically reduce the combined risk of heart attack, stroke, or CV death compared to standard support. However, achieving larger weight loss (10%+) and improved fitness was associated with reduced risk of CV death and major cardiac events. Continue lifestyle efforts for overall health and specific risk reduction, even if the broad 'heart attack prevention' claim is statistically unproven in this specific trial design.
Look AHEAD... was stopped on September 14, 2012, on the basis of a futility analysis of its composite primary end point (death from cardiovascular causes, nonfatal myocardial infarction [MI], nonfatal stroke, or hospitalization for angina)... Its results have been widely interpreted as evidence that weight loss with lifestyle intervention does not confer CVD benefits in patients with diabetes mellitus.
Why this rating
Large sample size (n=5145), long duration (median 9.6 years), but stopped for futility and had a high-intensity control arm.
Source
Looking Back at Look AHEAD Through the Lens of Recent Diabetes Outcome Trials
L. Maria Belalcazar et al. · Circulation · 2017
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