Look AHEAD

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Look AHEAD ( A ction for Hea lth in D iabetes) was begun in 2001, multicenter, randomized controlled trial , designed to determine whether intentional weight reduction cardiovascular morbidity and mortality decreases in overweight individuals with type 2 diabetes. The study included 5145 subjects and took place at 16 US clinical centers. It was terminated prematurely in 2012 following a futility analysis .

Look AHED is probably the largest randomized controlled trial designed to investigate the effects of weight loss on cardiovascular disease in type 2 diabetics. She achieved perhaps the largest long-term cumulative weight loss in a large study.

target group

The target group of the study were patients with type 2 diabetes and overweight or obesity . 5145 people, 60% women, mean age 59 years were included. All subjects were treated at baseline largely optimal medication, so were already antihypertensives , cholesterol-lowering , antidiabetic agents , etc.

Target values

Total mortality was chosen as the primary target variable, secondary target values ​​were typical comorbidities of type 2 diabetes, but also classic surrogate parameters (body weight, blood pressure, etc.)

execution

Look AHEAD was started in 2001 and canceled prematurely in 2012. The study was carried out at 16 centers in the United States.

methodology

The subjects in the intervention group received a close-knit counseling program over a year, followed by annual follow-up counseling. The focus of the consultation was weight reduction , but also increasing exercise and improving the nutritional quality in the sense of a low-fat diet through classic foods or, if necessary, formula products. The control group received advisory meetings at longer intervals with a general focus on content.

Results

Despite significantly greater weight reduction and significantly better values ​​for blood sugar, blood pressure and blood lipids in the intervention group in the first few years, the test subjects returned to their initial weight within 10 years. The study was terminated prematurely after 10 years because there was no significant difference in mortality between the groups . The intervention group achieved the same mortality but with significantly less medication, significantly fewer secondary diseases and a significantly better quality of life . An increase in the incidence of bone fractures was observed as a disadvantage of lifestyle intervention.

One reason for the lack of proof of benefit is that both groups received optimal medication at the start of the study. This masked the benefits of the lifestyle change, so that only a decrease in medication was visible in the intervention group.

The first publication in 2013 was followed by hundreds of other works. These were able to show, for example, that patients with a stronger response to lifestyle measures to body weight and other parameters actually also benefited in terms of mortality, but not other patients.

Individual evidence

  1. ^ The Look AHEAD Research Group: Cardiovascular Effects of Intensive Lifestyle Intervention in Type 2 Diabetes . In: The New England Journal of Medicine . tape 369 , no. 2 , July 11, 2013, p. 145–154 , doi : 10.1056 / NEJMoa1212914 (English).
  2. ^ The Look AHEAD Research Group: The Look AHEAD Study: A Description of the Lifestyle Intervention and the Evidence Supporting It . In: Obesity . tape 14 , no. 5 , September 6, 2012, doi : 10.1038 / oby.2006.84 (English).
  3. ^ Edward W. Gregg, Rena Wing: Looking again at the Look AHEAD study . In: The Lancet Diabetes & Endocrinology . tape 5 , no. 10 , July 12, 2017, p. 757-838 , doi : 10.1016 / S2213-8587 (17) 30238-3 (English).
  4. ↑ B. Willms: Look Ahead study - Results after four years • diabetologie online. Retrieved April 25, 2020 .
  5. ↑ a b c Cardiovascular Effects of Intensive Lifestyle Intervention in Type 2 Diabetes . In: New England Journal of Medicine . tape 369 , no. 2 , July 11, 2013, ISSN  0028-4793 , p. 145–154 , doi : 10.1056 / NEJMoa1212914 , PMID 23796131 , PMC 3791615 (free full text).
  6. ↑ LOOKAHEADE. Retrieved April 25, 2020 .
  7. ^ Cardiovascular Effects of Intensive Lifestyle Intervention in Type 2 Diabetes . In: New England Journal of Medicine . tape 369 , no. 2 , July 11, 2013, ISSN  0028-4793 , p. 145–154 , doi : 10.1056 / NEJMoa1212914 , PMID 23796131 , PMC 3791615 (free full text).
  8. ↑ Weight loss in the "Look AHEAD" study in diabetes patients. Retrieved April 25, 2020 .
  9. ↑ Deutscher Ärzteverlag GmbH, editorial office of Deutsches Ärzteblatt: Why a healthy lifestyle for diabetics shouldn't be before heart attacks ... June 25, 2013, accessed on April 25, 2020 .
  10. ^ Cardiovascular Effects of Intensive Lifestyle Intervention in Type 2 Diabetes . In: New England Journal of Medicine . tape 369 , no. 2 , July 11, 2013, ISSN  0028-4793 , p. 145–154 , doi : 10.1056 / NEJMoa1212914 , PMID 23796131 , PMC 3791615 (free full text).
  11. ↑ Look AHEAD Trial Halted After Finding No CV Benefits of Intensive Lifestyle Intervention in Diabetes. Retrieved April 25, 2020 .
  12. ^ Tamar I. de Vries, Jannick AN Dorresteijn, Yolanda van der Graaf, Frank LJ Visseren, Jan Westerink: Heterogeneity of Treatment Effects From an Intensive Lifestyle Weight Loss Intervention on Cardiovascular Events in Patients With Type 2 Diabetes: Data From the Look AHEAD Trial . In: Diabetes Care . September 4, 2019, ISSN  0149-5992 , doi : 10.2337 / dc19-0776 , PMID 31416897 ( diabetesjournals.org [accessed April 25, 2020]).
  13. ↑ Change of lifestyle pays off. Retrieved April 25, 2020 .