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Weight Loss, Exercise Not Enough to Lower Heart Attack and Stroke Risk in Some Patients with Type 2 Diabetes

Release date: 6/25/2013

Healthy eating and exercise are still important for improving overall health, diabetes experts caution. 

Jeanne Clark Dr. Jeanne Clark

Johns Hopkins diabetes experts urge caution in reaction to results of a study released Monday that found weight loss and lifestyle changes had little effect on the long-term cardiovascular health of patients with type 2 diabetes.

For over 11 years, the “Look AHEAD” clinical trial studied more than 5,000 overweight patients between the ages of 45 and 76 who were diagnosed with type 2 diabetes. The results, released Monday in Chicago at the American Diabetes Association’s 73rd Scientific Sessions and published in The New England Journal of Medicine, concluded that weight loss achieved through diet and exercise did not reduce those patients’ risk for heart attack and stroke.

That should not discourage people with type 2 diabetes from eating healthier and exercising, says Jeanne M. Clark, M.D., M.P.H., one of the principal investigators on the study and the Frederick Brancati, M.D., Professor of Medicine and interim director of the Division of General Internal Medicine at the Johns Hopkins University School of Medicine.

“That would be the wrong message,” Clark says. “Weight loss and exercise do matter. We found that patients led better, healthier lives when they lost weight and got more exercise. Their blood sugar levels improved, their blood pressure was better, they were less prone to depression. There were numerous benefits to the intensive lifestyle intervention that the Look AHEAD trial studied.”

A Pretty Motivated Group

At 16 centers across the country, the National Institutes of Health-funded Look AHEAD (Action for Health in Diabetes) trial examined the long-term effects of exercise and healthier eating on adult patients with type 2 diabetes. It compared the effects of weight loss and healthier eating habits with a control group of patients receiving only diabetes support and education.

With a median follow-up of 9.6 years, the study’s participants showed no decreased risk of heart attack or stroke.

Clark says both groups of participants generally had a lower incidence of cardiovascular problems over the course of the study, which could account for the lack of change in risk. “We’ve found that people who enter studies like these are generally healthier,” she says. “This was a pretty motivated group. The intervention group lost an average of 8.6 percent of their body weight in the first year and maintained a 6 percent loss. They joined this study and stayed committed.”

Though risk of heart attack and stroke was unchanged, the study showed that weight loss, exercise and an improved diet led to better results in many other health measures. “We saw a reduction in eye disease and in kidney disease,” Clark says. “There were improvements in areas like sleep apnea, sexual function and incontinence. And we saw lower health care costs, as a result of reduced hospitalizations.”

Clark sees important takeaways from the Look AHEAD study.

“For adults living with type 2 diabetes, better fitness and losing weight do matter, even if the heart attack and stroke risk isn’t apparent,” she said. “You live better.”

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Patrick Smith