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

Osama Hamdy, Adham Mottalib, Amr Morsi, Nuha El-Sayed, Ann Goebel-Fabbri, Gillian Arathuzik, Jacqueline Shahar, Amanda Kirpitch, John Zrebiec, Osama Hamdy, Adham Mottalib, Amr Morsi, Nuha El-Sayed, Ann Goebel-Fabbri, Gillian Arathuzik, Jacqueline Shahar, Amanda Kirpitch, John Zrebiec

Abstract

Objective: We evaluated long-term impact of sustained weight loss versus weight regain on cardiovascular risk factors in real-world clinical practice.

Methods: We 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.

Results: The 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.

Conclusions: Weight 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 number: NCT01937845.

Keywords: Cardiovascular Disease Risk; Lifestyle Intervention(s); Weight Management.

Conflict of interest statement

OH receives research support from Neurometrix and Metagenics and consults to Merck Pharmaceutical and Abbott Nutrition. None of the authors’ financial interests are related or influenced this study. Other authors do not have any competing interests to disclose.

Figures

Figure 1
Figure 1
Flow chart of participants in the 5-year follow-up after intensive lifestyle intervention using the Why WAIT model in clinical practice.
Figure 2
Figure 2
Percentage of weight loss over 5 years in response to 12-week intensive lifestyle intervention in a real-world clinical practice. All participants N=129. Group A, n=61 (participants maintained

Figure 3

Change in %A1C over 5…

Figure 3

Change in %A1C over 5 years in response to 12-week intensive lifestyle intervention…

Figure 3
Change in %A1C over 5 years in response to 12-week intensive lifestyle intervention used in a real-world clinical practice. All participants N=129. Group A, n=61 (participants maintained

Figure 4

Change in (A) total cholesterol;…

Figure 4

Change in (A) total cholesterol; (B) LDL-cholesterol; (C) HDL-cholesterol and (D) triglycerides over…

Figure 4
Change in (A) total cholesterol; (B) LDL-cholesterol; (C) HDL-cholesterol and (D) triglycerides over 5 years in response to 12-week intensive lifestyle intervention in a real-world clinical practice. All participants, N=129. Group A, n=61 (participants maintained

Figure 5

Change in (A) systolic blood…

Figure 5

Change in (A) systolic blood pressure and (B) diastolic blood pressure over 5…

Figure 5
Change in (A) systolic blood pressure and (B) diastolic blood pressure over 5 years in response to 12-week intensive lifestyle intervention in a real-world clinical practice. All participants, N=129. Group A, n=61 (participants maintained
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References
    1. Evert AB, Boucher JL, Cypress M et al. . Nutrition therapy recommendations for the management of adults with diabetes. Diabetes Care 2013;36:3821–42. 10.2337/dc13-2042 - DOI - PMC - PubMed
    1. Garber AJ, Abrahamson MJ, Barzilay JI et al. . American Association of Clinical Endocrinologists’ comprehensive diabetes management algorithm 2013 consensus statement—executive summary. Endocr Pract 2013;19:536–57. 10.4158/EP13176.CS - DOI - PMC - PubMed
    1. Hamdy O, Ledbury S, Mullooly C et al. . Lifestyle modification improves endothelial function in obese subjects with the insulin resistance syndrome. Diabetes Care 2003;26:2119–25. 10.2337/diacare.26.7.2119 - DOI - PubMed
    1. Monzillo LU, Hamdy O, Horton ES et al. . Effect of lifestyle modification on adipokine levels in obese subjects with insulin resistance. Obes Res 2003;11:1048–54. 10.1038/oby.2003.144 - DOI - PubMed
    1. Zanuso S, Jimenez A, Pugliese G et al. . Exercise for the management of type 2 diabetes: a review of the evidence. Acta Diabetol 2010;47:15–22. 10.1007/s00592-009-0126-3 - DOI - PubMed
Show all 28 references
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Figure 3
Figure 3
Change in %A1C over 5 years in response to 12-week intensive lifestyle intervention used in a real-world clinical practice. All participants N=129. Group A, n=61 (participants maintained

Figure 4

Change in (A) total cholesterol;…

Figure 4

Change in (A) total cholesterol; (B) LDL-cholesterol; (C) HDL-cholesterol and (D) triglycerides over…

Figure 4
Change in (A) total cholesterol; (B) LDL-cholesterol; (C) HDL-cholesterol and (D) triglycerides over 5 years in response to 12-week intensive lifestyle intervention in a real-world clinical practice. All participants, N=129. Group A, n=61 (participants maintained

Figure 5

Change in (A) systolic blood…

Figure 5

Change in (A) systolic blood pressure and (B) diastolic blood pressure over 5…

Figure 5
Change in (A) systolic blood pressure and (B) diastolic blood pressure over 5 years in response to 12-week intensive lifestyle intervention in a real-world clinical practice. All participants, N=129. Group A, n=61 (participants maintained
Similar articles
Cited by
References
    1. Evert AB, Boucher JL, Cypress M et al. . Nutrition therapy recommendations for the management of adults with diabetes. Diabetes Care 2013;36:3821–42. 10.2337/dc13-2042 - DOI - PMC - PubMed
    1. Garber AJ, Abrahamson MJ, Barzilay JI et al. . American Association of Clinical Endocrinologists’ comprehensive diabetes management algorithm 2013 consensus statement—executive summary. Endocr Pract 2013;19:536–57. 10.4158/EP13176.CS - DOI - PMC - PubMed
    1. Hamdy O, Ledbury S, Mullooly C et al. . Lifestyle modification improves endothelial function in obese subjects with the insulin resistance syndrome. Diabetes Care 2003;26:2119–25. 10.2337/diacare.26.7.2119 - DOI - PubMed
    1. Monzillo LU, Hamdy O, Horton ES et al. . Effect of lifestyle modification on adipokine levels in obese subjects with insulin resistance. Obes Res 2003;11:1048–54. 10.1038/oby.2003.144 - DOI - PubMed
    1. Zanuso S, Jimenez A, Pugliese G et al. . Exercise for the management of type 2 diabetes: a review of the evidence. Acta Diabetol 2010;47:15–22. 10.1007/s00592-009-0126-3 - DOI - PubMed
Show all 28 references
Associated data
Related information
LinkOut - more resources
Full text links [x]
[x]
Cite
Copy Download .nbib
Format: AMA APA MLA NLM

NCBI Literature Resources

MeSH PMC Bookshelf Disclaimer

The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Unauthorized use of these marks is strictly prohibited.

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Figure 4
Figure 4
Change in (A) total cholesterol; (B) LDL-cholesterol; (C) HDL-cholesterol and (D) triglycerides over 5 years in response to 12-week intensive lifestyle intervention in a real-world clinical practice. All participants, N=129. Group A, n=61 (participants maintained

Figure 5

Change in (A) systolic blood…

Figure 5

Change in (A) systolic blood pressure and (B) diastolic blood pressure over 5…

Figure 5
Change in (A) systolic blood pressure and (B) diastolic blood pressure over 5 years in response to 12-week intensive lifestyle intervention in a real-world clinical practice. All participants, N=129. Group A, n=61 (participants maintained
Similar articles
Cited by
References
    1. Evert AB, Boucher JL, Cypress M et al. . Nutrition therapy recommendations for the management of adults with diabetes. Diabetes Care 2013;36:3821–42. 10.2337/dc13-2042 - DOI - PMC - PubMed
    1. Garber AJ, Abrahamson MJ, Barzilay JI et al. . American Association of Clinical Endocrinologists’ comprehensive diabetes management algorithm 2013 consensus statement—executive summary. Endocr Pract 2013;19:536–57. 10.4158/EP13176.CS - DOI - PMC - PubMed
    1. Hamdy O, Ledbury S, Mullooly C et al. . Lifestyle modification improves endothelial function in obese subjects with the insulin resistance syndrome. Diabetes Care 2003;26:2119–25. 10.2337/diacare.26.7.2119 - DOI - PubMed
    1. Monzillo LU, Hamdy O, Horton ES et al. . Effect of lifestyle modification on adipokine levels in obese subjects with insulin resistance. Obes Res 2003;11:1048–54. 10.1038/oby.2003.144 - DOI - PubMed
    1. Zanuso S, Jimenez A, Pugliese G et al. . Exercise for the management of type 2 diabetes: a review of the evidence. Acta Diabetol 2010;47:15–22. 10.1007/s00592-009-0126-3 - DOI - PubMed
Show all 28 references
Associated data
Related information
LinkOut - more resources
Full text links [x]
[x]
Cite
Copy Download .nbib
Format: AMA APA MLA NLM
Figure 5
Figure 5
Change in (A) systolic blood pressure and (B) diastolic blood pressure over 5 years in response to 12-week intensive lifestyle intervention in a real-world clinical practice. All participants, N=129. Group A, n=61 (participants maintained

References

    1. Evert AB, Boucher JL, Cypress M et al. . Nutrition therapy recommendations for the management of adults with diabetes. Diabetes Care 2013;36:3821–42. 10.2337/dc13-2042
    1. Garber AJ, Abrahamson MJ, Barzilay JI et al. . American Association of Clinical Endocrinologists’ comprehensive diabetes management algorithm 2013 consensus statement—executive summary. Endocr Pract 2013;19:536–57. 10.4158/EP13176.CS
    1. Hamdy O, Ledbury S, Mullooly C et al. . Lifestyle modification improves endothelial function in obese subjects with the insulin resistance syndrome. Diabetes Care 2003;26:2119–25. 10.2337/diacare.26.7.2119
    1. Monzillo LU, Hamdy O, Horton ES et al. . Effect of lifestyle modification on adipokine levels in obese subjects with insulin resistance. Obes Res 2003;11:1048–54. 10.1038/oby.2003.144
    1. Zanuso S, Jimenez A, Pugliese G et al. . Exercise for the management of type 2 diabetes: a review of the evidence. Acta Diabetol 2010;47:15–22. 10.1007/s00592-009-0126-3
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