Impact of intensive lifestyle intervention on depression and health-related quality of life in type 2 diabetes: the Look AHEAD Trial

Richard R Rubin, Thomas A Wadden, Judy L Bahnson, George L Blackburn, Frederick L Brancati, George A Bray, Mace Coday, Scott J Crow, Jeffrey M Curtis, Gareth Dutton, Caitlin Egan, Mary Evans, Lin Ewing, Lucy Faulconbridge, John Foreyt, Sarah A Gaussoin, Edward W Gregg, Helen P Hazuda, James O Hill, Edward S Horton, Van S Hubbard, John M Jakicic, Robert W Jeffery, Karen C Johnson, Steven E Kahn, William C Knowler, Wei Lang, Cora E Lewis, Maria G Montez, Anne Murillo, David M Nathan, Jennifer Patricio, Anne Peters, Xavier Pi-Sunyer, Henry Pownall, W Jack Rejeski, Renate H Rosenthal, Valerie Ruelas, Katie Toledo, Brent Van Dorsten, Mara Vitolins, Donald Williamson, Rina R Wing, Susan Z Yanovski, Ping Zhang, Look AHEAD Research Group, Cora E Lewis, Lawrence Cheskin, Richard S Crow, Lawrence M Friedman, Stephen Glasser, Patricia Hogan, Karen C Johnson, David Lefkowitz, Ron Prineas, J Bruce Redmon, Patrick S Reynolds, Monika Safford, Tandaw Samdarshi, Carrie C Williams, John M Jakicic, James O Hill, Ashok Balasubramanyam, George Blackburn, Lawton S Cooper, Kathy M Dotson, Mary Evans, Gary Foster, Jeanne McCaffery, David Reboussin, George A Bray, Sheikilya Thomas, Richard S Crow, Mary Evans, Edward W Gregg, James O Hill, Amelia Hodges, Robert W Jeffery, Tina Killean, Maria G Montez, David Reboussin, Lee Swartz, Richard Rubin, Frederick L Brancati, Judy L Bahnson, Kathy M Dotson, Mark A Espeland, Mary Evans, Cora E Lewis, Barbara J Maschak-Carey, David M Nathan, Delia S West, Rina R Wing, Jacqueline Wesche-Thobaben, Ann Peters, Jeanne M Clark, Abbas E Kitabchi, Judy L Bahnson, Caitlin Egan, Mary Evans, Valerie Goldman, Amelia Hodges, Dominique Limprevil-Divers, Juliet Mancino, Cathy Manus, Tricia Skarphol, J Lee Taylor, Henry Glick, William C Knowler, Alain C Bertoni, Brenda L Craven, Kathy M Dotson, Mark A Espeland, Mary Evans, Richard Hamman, Don G Hire, Tina Killean, Michael S Lawlor, Dominque Limprevil-Divers, Maria G Montez, Julia T Rushing, Adam G Tsai, David F Williamson, Ping Zhang, Judy L Bahnson, Mark A Espeland, Mary Evans, Barbara Harrison, Xavier Pi-Sunyer, Lynne E Wagenknecht, Rina R Wing, Barbara Maschak-Carey, Marsha Miller, Brenda Montgomery, Judy L Bahnson, Paula Bolin, Kathy M Dotson, Caitlin Egan, Mary Evans, Molly Gee, Siran Gharazian, Valerie Goldman, Carolyn Gresham, Barbara Harrison, Diane Hirsch, Amelia Hodges, Sharon D Jackson, Tina Killean, Helen Lambeth, Dominique Limprevil-Divers, Maria G Montez, Moana Mosby, Anne Murillo, Jennifer Patricio, Rebecca Reeves, Tricia Skarphol, Allison Strate, Lee Swartz, Sheikilya Thomas, Carolyn Thorson, Jacqueline Wesche-Thobaben, Carrie C Williams, Rina R Wing, Jeanne M Clark, Donna H Ryan, Mark A Espeland, Edward W Gregg, Amelia Hodges, Van S Hubbard, Karen C Johnson, Steven E Kahn, Abbas E Kitabchi, William C Knowler, Dominique Limprevil--Divers, David M Nathan, Xavier Pi-Sunyer, Monika Safford, Lynne E Wagenknecht, Carrie C Williams, Rena R Wing, Susan Z Yanovski, Jennifer Patricio, Lynne Lichtermann, Jennifer Arceneaux, Jeanne Charleston, Kathy M Dotson, Caitlin Egan, Mary Evans, Richard Foushee, Molly Gee, Carolyn Gresham, Nancy J Hall, Ruby Johnson, Robert Knopp, Helen Lambeth, Rebecca Reeves, Richard Rubin, Allison Strate, Brent Van Dorsten, Frederick L Brancati, David Kelly, Judy L Bahnson, Alain G Bertoni, Lawton S Cooper, Jeffrey M Curtis, Sarah A Gaussoin, Siran Ghazarian, Van S Hubbard, Steven E Kahn, Barbara Maschak-Carey, Anne Murillo, Anne Peters, Xavier Pi-Sunyer, Susan Z Yanovski, Rina R Wing, Xavier Pi-Sunyer, Frederick L Brancati, George A Bray, Jeanne M Clark, Jeffrey M Curtis, Mark A Espeland, Mary Evans, John P Foreyt, Steven Haffner, Barbara Harrison, Helen P Hazuda, James O Hill, Edward S Horton, John M Jakicic, Robert W Jeffery, Karen C Johnson, Steven E Kahn, David Kelly, Abbas E Kitabchi, William C Knowler, Cora E Lewis, David M Nathan, Anne Peters, Thomas A Wadden, Lynne E Wagenknecht, Thomas A Wadden, Delia S West, John P Bantle, Robert I Berkowitz, Paula Bolin, Barbara Cerniauskas, Linda Delahanty, Kathy M Dotson, Mary Evans, John P Foreyt, Edward W Gregg, Helen P Hazuda, John M Jakicic, Shiriki Kumanyika, Marsha Miller, Carmen Pal, Rebecca Reeves, W Jack Rejeski, Amy D Rickman, Mara Vitolins, Don Williamson, Rena R Wing, Susan Z Yanovski, Richard R Rubin, Thomas A Wadden, Judy L Bahnson, George L Blackburn, Frederick L Brancati, George A Bray, Mace Coday, Scott J Crow, Jeffrey M Curtis, Gareth Dutton, Caitlin Egan, Mary Evans, Lin Ewing, Lucy Faulconbridge, John Foreyt, Sarah A Gaussoin, Edward W Gregg, Helen P Hazuda, James O Hill, Edward S Horton, Van S Hubbard, John M Jakicic, Robert W Jeffery, Karen C Johnson, Steven E Kahn, William C Knowler, Wei Lang, Cora E Lewis, Maria G Montez, Anne Murillo, David M Nathan, Jennifer Patricio, Anne Peters, Xavier Pi-Sunyer, Henry Pownall, W Jack Rejeski, Renate H Rosenthal, Valerie Ruelas, Katie Toledo, Brent Van Dorsten, Mara Vitolins, Donald Williamson, Rina R Wing, Susan Z Yanovski, Ping Zhang, Look AHEAD Research Group, Cora E Lewis, Lawrence Cheskin, Richard S Crow, Lawrence M Friedman, Stephen Glasser, Patricia Hogan, Karen C Johnson, David Lefkowitz, Ron Prineas, J Bruce Redmon, Patrick S Reynolds, Monika Safford, Tandaw Samdarshi, Carrie C Williams, John M Jakicic, James O Hill, Ashok Balasubramanyam, George Blackburn, Lawton S Cooper, Kathy M Dotson, Mary Evans, Gary Foster, Jeanne McCaffery, David Reboussin, George A Bray, Sheikilya Thomas, Richard S Crow, Mary Evans, Edward W Gregg, James O Hill, Amelia Hodges, Robert W Jeffery, Tina Killean, Maria G Montez, David Reboussin, Lee Swartz, Richard Rubin, Frederick L Brancati, Judy L Bahnson, Kathy M Dotson, Mark A Espeland, Mary Evans, Cora E Lewis, Barbara J Maschak-Carey, David M Nathan, Delia S West, Rina R Wing, Jacqueline Wesche-Thobaben, Ann Peters, Jeanne M Clark, Abbas E Kitabchi, Judy L Bahnson, Caitlin Egan, Mary Evans, Valerie Goldman, Amelia Hodges, Dominique Limprevil-Divers, Juliet Mancino, Cathy Manus, Tricia Skarphol, J Lee Taylor, Henry Glick, William C Knowler, Alain C Bertoni, Brenda L Craven, Kathy M Dotson, Mark A Espeland, Mary Evans, Richard Hamman, Don G Hire, Tina Killean, Michael S Lawlor, Dominque Limprevil-Divers, Maria G Montez, Julia T Rushing, Adam G Tsai, David F Williamson, Ping Zhang, Judy L Bahnson, Mark A Espeland, Mary Evans, Barbara Harrison, Xavier Pi-Sunyer, Lynne E Wagenknecht, Rina R Wing, Barbara Maschak-Carey, Marsha Miller, Brenda Montgomery, Judy L Bahnson, Paula Bolin, Kathy M Dotson, Caitlin Egan, Mary Evans, Molly Gee, Siran Gharazian, Valerie Goldman, Carolyn Gresham, Barbara Harrison, Diane Hirsch, Amelia Hodges, Sharon D Jackson, Tina Killean, Helen Lambeth, Dominique Limprevil-Divers, Maria G Montez, Moana Mosby, Anne Murillo, Jennifer Patricio, Rebecca Reeves, Tricia Skarphol, Allison Strate, Lee Swartz, Sheikilya Thomas, Carolyn Thorson, Jacqueline Wesche-Thobaben, Carrie C Williams, Rina R Wing, Jeanne M Clark, Donna H Ryan, Mark A Espeland, Edward W Gregg, Amelia Hodges, Van S Hubbard, Karen C Johnson, Steven E Kahn, Abbas E Kitabchi, William C Knowler, Dominique Limprevil--Divers, David M Nathan, Xavier Pi-Sunyer, Monika Safford, Lynne E Wagenknecht, Carrie C Williams, Rena R Wing, Susan Z Yanovski, Jennifer Patricio, Lynne Lichtermann, Jennifer Arceneaux, Jeanne Charleston, Kathy M Dotson, Caitlin Egan, Mary Evans, Richard Foushee, Molly Gee, Carolyn Gresham, Nancy J Hall, Ruby Johnson, Robert Knopp, Helen Lambeth, Rebecca Reeves, Richard Rubin, Allison Strate, Brent Van Dorsten, Frederick L Brancati, David Kelly, Judy L Bahnson, Alain G Bertoni, Lawton S Cooper, Jeffrey M Curtis, Sarah A Gaussoin, Siran Ghazarian, Van S Hubbard, Steven E Kahn, Barbara Maschak-Carey, Anne Murillo, Anne Peters, Xavier Pi-Sunyer, Susan Z Yanovski, Rina R Wing, Xavier Pi-Sunyer, Frederick L Brancati, George A Bray, Jeanne M Clark, Jeffrey M Curtis, Mark A Espeland, Mary Evans, John P Foreyt, Steven Haffner, Barbara Harrison, Helen P Hazuda, James O Hill, Edward S Horton, John M Jakicic, Robert W Jeffery, Karen C Johnson, Steven E Kahn, David Kelly, Abbas E Kitabchi, William C Knowler, Cora E Lewis, David M Nathan, Anne Peters, Thomas A Wadden, Lynne E Wagenknecht, Thomas A Wadden, Delia S West, John P Bantle, Robert I Berkowitz, Paula Bolin, Barbara Cerniauskas, Linda Delahanty, Kathy M Dotson, Mary Evans, John P Foreyt, Edward W Gregg, Helen P Hazuda, John M Jakicic, Shiriki Kumanyika, Marsha Miller, Carmen Pal, Rebecca Reeves, W Jack Rejeski, Amy D Rickman, Mara Vitolins, Don Williamson, Rena R Wing, Susan Z Yanovski

Abstract

Objective: We examined the effects of an intensive lifestyle intervention (ILI), compared with a diabetes support and education (DSE) control intervention, on long-term changes in depression symptoms, antidepressant medication (ADM) use, and health-related quality of life (HRQoL) in overweight/obese individuals with type 2 diabetes.

Research design and methods: Look AHEAD was a multisite randomized controlled trial of 5,145 overweight/obese participants assigned to ILI (designed to produce weight loss) or DSE and followed for a median of 9.6 years. The Beck Depression Inventory (BDI) was administered at baseline, annually at years 1-4, and again at year 8. Mean BDI scores and incidence of BDI scores ≥10, indicative of likely mild or greater depression, were examined. Annually through year 10, participants reported their ADM use and completed the Medical Outcomes Study Short Form 36 (SF-36) questionnaire, which yields physical component summary (PCS) and mental component summary (MCS) scores.

Results: ILI significantly reduced the incidence of mild or greater depression symptoms (BDI scores ≥10) compared with DSE (hazard ratio [HR] = 0.85; 95% CI 0.75-0.97; P = 0.0145). Although SF-36 PCS scores worsened over time in both groups, ILI participants reported better physical function than DSE throughout the first 8 years (all P values <0.01). There were no significant differences between treatment arms in the proportion of participants who used ADMs or in SF-36 MCS scores.

Conclusions: ILI for overweight/obese patients with type 2 diabetes may reduce the risk of developing clinically significant symptoms of depression and preserve physical HRQoL. These findings should be considered when evaluating the potential benefits of ILIs.

Trial registration: ClinicalTrials.gov NCT00017953.

© 2014 by the American Diabetes Association.

Figures

Figure 1
Figure 1
CONSORT flow diagram.
Figure 2
Figure 2
(A) Cumulative HR (ILI versus DSE) for incidence of BDI ≥10 over 8 years in participants with BDI <10 at baseline. (B) Mean BDI score over 8 years by treatment arm for the full sample of participants. The sample size for DSE appears above the sample size for ILI for each year the BDI was administered. (C) Mean BDI score over 8 years by treatment arm for participants with a baseline BDI score <10 (indicative of no/minimal symptoms of depression). The sample size for DSE appears above the sample size for ILI for each year the BDI was administered. (D) Mean BDI score over 8 years by treatment arm for participants with a baseline BDI score ≥10 (indicative of mild or greater symptoms of depression). The sample size for DSE appears above the sample size for ILI for each year the BDI was administered. *, significant differences between groups (P < 0.005).
Figure 3
Figure 3
(A) Mean PCS scores over 10 years by treatment arm. The sample size for DSE appears the above sample size for ILI. *, significant differences between groups (P < 0.005). (B) Mean MCS scores over 10 years by treatment arm. The sample size for DSE appears above the sample size for ILI.

References

    1. Egede LE, Zheng D. Independent factors associated with major depressive disorder in a national sample of individuals with diabetes. Diabetes Care 2003;26:104–111
    1. Goldney RD, Phillips PJ, Fisher LJ, Wilson DH. Diabetes, depression, and quality of life: a population study. Diabetes Care 2004;27:1066–1070
    1. Manuel DG, Schultz SE. Health-related quality of life and health-adjusted life expectancy of people with diabetes in Ontario, Canada, 1996-1997. Diabetes Care 2004;27:407–414
    1. Lustman PJ, Clouse RE. Depression in diabetic patients: the relationship between mood and glycemic control. J Diabetes Complications 2005;19:113–122
    1. Egede LE, Nietert PJ, Zheng D. Depression and all-cause and coronary heart disease mortality among adults with and without diabetes. Diabetes Care 2005;28:1339–1345
    1. Egede LE, Zheng D, Simpson K. Comorbid depression is associated with increased health care use and expenditures in individuals with diabetes. Diabetes Care 2002;25:464–470
    1. Haslam DW, James WP. Obesity. Lancet 2005;366:1197–1209
    1. Flegal KM, Graubard BI, Williamson DF, Gail MH. Excess deaths associated with underweight, overweight, and obesity. JAMA 2005;293:1861–1867
    1. Onyike CU, Crum RM, Lee HB, Lyketsos CG, Eaton WW. Is obesity associated with major depression? Results from the Third National Health and Nutrition Examination Survey. Am J Epidemiol 2003;158:1139–1147
    1. Strine TW, Mokdad AH, Dube SR, et al. The association of depression and anxiety with obesity and unhealthy behaviors among community-dwelling US adults. Gen Hosp Psychiatry 2008;30:127–137
    1. Jia H, Lubetkin EI. The impact of obesity on health-related quality-of-life in the general adult US population. J Public Health (Oxf) 2005;27:156–164
    1. Anandacoomarasamy A, Caterson ID, Leibman S, et al. Influence of BMI on health-related quality of life: comparison between an obese adult cohort and age-matched population norms. Obesity (Silver Spring) 2009;17:2114–2118
    1. Wadden TA, West DS, Delahanty L, et al. Look AHEAD Research Group The Look AHEAD study: a description of the lifestyle intervention and the evidence supporting it. Obesity (Silver Spring) 2006;14:737–752
    1. Wing RR, Lang W, Wadden TA, et al. Look AHEAD Research Group Benefits of modest weight loss in improving cardiovascular risk factors in overweight and obese individuals with type 2 diabetes. Diabetes Care 2011;34:1481–1486
    1. Beck AT, Steer RA. Manual for the Beck Depression Inventory. San Antonio, Psychological Corporation, 1987
    1. Wing RR, Blair E, Marcus M, Epstein LH, Harvey J. Year-long weight loss treatment for obese patients with type II diabetes: does including an intermittent very-low-calorie diet improve outcome? Am J Med 1994;97:354–362
    1. Faulconbridge LF, Wadden TA, Rubin RR, et al. Look AHEAD Research Group One-year changes in symptoms of depression and weight in overweight/obese individuals with type 2 diabetes in the Look AHEAD study. Obesity (Silver Spring) 2012;20:783–793
    1. Wadden TA, Vogt RA, Andersen RE, et al. Exercise in the treatment of obesity: effects of four interventions on body composition, resting energy expenditure, appetite, and mood. J Consult Clin Psychol 1997;65:269–277
    1. Ware JE, Kosinski M, Keller SD. SF-36 Physical and Mental Health Summary Scales: A User’s Manual. Boston, New England Medical Center, 1994
    1. Ackermann RT, Edelstein SL, Narayan KM, et al. Diabetes Prevention Program Research Group Changes in health state utilities with changes in body mass in the Diabetes Prevention Program. Obesity (Silver Spring) 2009;17:2176–2181
    1. Williamson DA, Rejeski J, Lang W, Van Dorsten B, Fabricatore AN, Toledo K, Look AHEAD Research Group Impact of a weight management program on health-related quality of life in overweight adults with type 2 diabetes. Arch Intern Med 2009;169:163–171
    1. Rubin RR, Peyrot M, Wang N-Y, et al. Patient-reported outcomes in the practice-based opportunities for weight reduction (POWER) trial. Qual Life Res 2013;22:2389–2398
    1. National Task Force on the Prevention and Treatment of Obesity. Dieting and the development of eating disorders in overweight and obese adults. Arch Intern Med 2000;160:2581–2589
    1. Ryan DH, Espeland MA, Foster GD, et al. Look AHEAD Research Group Look AHEAD (Action for Health in Diabetes): design and methods for a clinical trial of weight loss for the prevention of cardiovascular disease in type 2 diabetes. Control Clin Trials 2003;24:610–628
    1. Pi-Sunyer X, Blackburn G, Brancati FL, et al. Look AHEAD Research Group Reduction in weight and cardiovascular disease risk factors in individuals with type 2 diabetes: one-year results of the look AHEAD trial. Diabetes Care 2007;30:1374–1383
    1. Wing RR, Bolin P, Brancati FL, et al. Look AHEAD Research Group Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N Engl J Med 2013;369:145–154
    1. Beck AT, Steer RA, Brown GK. Manual for the Beck Depression Inventory-II. San Antonio, Psychological Corporation, 1996
    1. McHorney CA, Ware JE, Jr, Lu JF, Sherbourne CD. The MOS 36-item Short-Form Health Survey (SF-36): III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups. Med Care 1994;32:40–66
    1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed.. Washington, DC, American Psychiatric Press, 2013
    1. World Health Organization The Global Burden of Disease: 2004 Update. Geneva, WHO Press, 2008
    1. Gonzalez JS, Peyrot M, McCarl LA, et al. Depression and diabetes treatment nonadherence: a meta-analysis. Diabetes Care 2008;31:2398–2403
    1. Ware JE, Jr, Bayliss MS, Rogers WH, Kosinski M, Tarlov AR. Differences in 4-year health outcomes for elderly and poor, chronically ill patients treated in HMO and fee-for-service systems. Results from the Medical Outcomes Study. JAMA 1996;276:1039–1047
    1. Hopman WM, Berger C, Joseph L, et al. CaMos Research Group The natural progression of health-related quality of life: results of a five-year prospective study of SF-36 scores in a normative population. Qual Life Res 2006;15:527–536
    1. Der-Martirosian C, Kritz-Silverstein D, Barrett-Connor E. Five-year stability in associations of health-related quality of life measures in community-dwelling older adults: the Rancho Bernardo Study. Qual Life Res 2010;19:1333–1341
    1. Jaeschke R, Singer J, Guyatt GH. Measurement of health status. Ascertaining the minimal clinically important difference. Control Clin Trials 1989;10:407–415
    1. Stewart AL, Greenfield S, Hays RD, et al. Functional status and well-being of patients with chronic conditions. Results from the Medical Outcomes Study. JAMA 1989;262:907–913
    1. Wyrwich KW, Tierney WM, Babu AN, Kroenke K, Wolinsky FD. A comparison of clinically important differences in health-related quality of life for patients with chronic lung disease, asthma, or heart disease. Health Serv Res 2005;40:577–591
    1. Warkentin LM, Das D, Majumdar SR, Johnson JA, Padwal RS. The effect of weight loss on health-related quality of life: systematic review and meta-analysis of randomized trials. Obes Rev 2013. [Epub ahead of print]
    1. Norris SL, McNally TK, Zhang X, et al. Published norms underestimate the health-related quality of life among persons with type 2 diabetes. J Clin Epidemiol 2011;64:358–365
    1. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 2001;16:606–613

Source: PubMed

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