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Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes (Look AHEAD)
In 5145 adults with type 2 diabetes, an intensive lifestyle intervention produced greater sustained weight loss and better risk factors than diabetes support and education but did not reduce the primary composite of cardiovascular death, MI, stroke, or hospitalisation for angina (HR 0.95, 95% CI 0.83 to 1.09, P=0.51) over a median 9.6-year follow-up.
Design
- n = 5145 overweight/obese adults with type 2 diabetes
- Intensive lifestyle intervention (ILI) promoting caloric reduction + physical activity vs diabetes support & education (DSE)
- Primary endpoint: CV death, nonfatal MI, nonfatal stroke, or hospitalisation for angina
- Median follow-up: 9.6 y (stopped early for futility on primary)
Weight & risk factors vs outcomes
- 1-year weight change: −8.6% (ILI) vs −0.7% (DSE); benefits persisted but narrowed by trial end (−6.0% vs −3.5% abstract summary)
- HbA1c / fitness / most CV risk factors favoured ILI early; LDL-C exception noted in abstract
- Primary events: 403 vs 418 (1.83 vs 1.92 /100 person-y); HR 0.95 (95% CI 0.83–1.09; P = 0.51)
Evidence hygiene
This is not a Mediterranean diet trial—filed here as a whole-package lifestyle anchor showing risk-factor improvement without significant primary MACE reduction in this population and follow-up window.
Publication
Look AHEAD Research Group. N Engl J Med. 2013 Jul 11;369(2):145-154. PMID 23796131.
Outcomes
- Primary composite (CV death, nonfatal MI, nonfatal stroke, hospitalisation for angina): HR 0.95 (95% CI 0.83–1.09; P=0.51), median follow-up 9.6 years—null for superiority despite greater weight loss on intensive lifestyle intervention.
- 1-year body-weight change: −8.6% intensive lifestyle vs −0.7% control; end-of-study summary −6.0% vs −3.5% (abstract).