In people with obesity and type 2 diabetes, an intensive lifestyle programme reduced disability

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We don’t usually include individual studies in diabetes because there are so many of them.  However, a new report of the Look AHEAD trial, published in the New England Journal of Medicine, points towards significant potential benefits from an intensive lifestyle intervention for people suffering from obesity and type 2 diabetes.

Clinical question:

In overweight or obese people with type 2 diabetes, does an intensive lifestyle intervention, as compared to usual care, lead to improvements in mobility?

The evidence:

5145 participants were randomly assigned to receive either an intensive lifestyle intervention or a control group (who received a diabetes support and education programme).  They were followed up for four years, with annual assessments of their mobility.

The researchers found that the patients in the lifestyle intervention were less likely to experience severe disability, and more likely to have good mobility than those in the control group.

Outcome Time to Outcome Control Lifestyle RRR ARR NNT
Severe disability 4 years 0.262 0.206 21% 0.056 18
95% Confidence Intervals: 12% to 30% 0.033 to 0.079 13 to 31
Good mobility 4 years 0.319 0.385 -21% -0.066 -15
95% Confidence Intervals: -29% to -12% -0.092 to -0.040 -25 to -11
  • RRR = Relative Risk Reduction
    ARR = Absolute Risk Reduction
    NNT = Number Needed to Treat

They concluded:

Weight loss and improved fitness slowed the decline in mobility in overweight adults with type 2 diabetes

Appraisal hints:

  • Was the treatment allocation concealed from the people who were recruiting patients?
  • Could the results be down to co-interventions?
  • This trial could not be blinded.
  • Could the self-reports of mobility be subject to bias?  What other outcomes are important here?
  • Could the intervention be delivered in your setting in the same way?  See below to access the full protocol of trial and details of the intervention.

Reference:

Rejeski WJ, Ip EH, Bertoni AG, Bray GA, Evans G, Gregg EW, Zhang Q; Look AHEAD Research Group. Lifestyle change and mobility in obese adults with type 2 diabetes. N Engl J Med. 2012 Mar 29;366(13):1209-17.

You can get the full protocol from the Look AHEAD website.

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Badenoch

Badenoch
I am an information scientist with an interest in making knowledge from systematic research more accessible to people who need it. This means you. I've been attempting this in the area of Evidence-Based Health Care since 1995. So far the results have been mixed. For some reason we expected busy clinicians to search databases and appraise papers instead of seeing patients. We also expected publishers to make the research freely available to the people who paid for it.. Ha! Hence The National Elf service.

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