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

• Published in: BMJ open diabetes research & care Vol. 5; no. 1; p. e000259
• Main Authors: Hamdy, Osama, Mottalib, Adham, Morsi, Amr, El-Sayed, Nuha, Goebel-Fabbri, Ann, Arathuzik, Gillian, Shahar, Jacqueline, Kirpitch, Amanda, Zrebiec, John
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01-01-2017; BMJ Publishing Group
• Subjects: Cardiovascular and Metabolic Risk; Cholesterol; Clinical medicine; Diabetes; Enrollments; Exercise; Gastrointestinal surgery; Lifestyles; Low density lipoprotein; Physical fitness; Primary care; Studies; Triglycerides; Weight control; Cardiovascular Disease Risk; Weight Management; Lifestyle Intervention(s)
• ISSN: 2052-4897; 2052-4897
• DOI: 10.1136/bmjdrc-2016-000259

ObjectiveWe evaluated long-term impact of sustained weight loss versus weight regain on cardiovascular risk factors in real-world clinical practice.MethodsWe 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.ResultsThe 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.ConclusionsWeight 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 numberNCT01937845.