Physical Function Following a Long-Term Lifestyle Intervention Among Middle Aged and Older Adults With Type 2 Diabetes: The Look AHEAD Study

IntroductionGlycemic variability may predict poor outcomes in type 2 diabetes. We evaluated the associations of long-term variability in glycosylated hemoglobin (HbA1C) and fasting plasma glucose (FPG) with cardiovascular disease (CVD) and death among individuals with type 2 diabetes.Research design and methodsWe conducted a secondary, prospective cohort analysis of the Look AHEAD (Action for Health in Diabetes) data, including 3560 participants who attended four visits (baseline, 12 months, 24 months, and 36 months) at the outset. Variability of HbA1C and FPG was assessed using four indices across measurements from four study visits. Participants without CVD during the first 36 months were followed for incident outcomes including a CVD composite (myocardial infarction, stroke, hospitalization for angina, and CVD-related deaths), heart failure (HF), and deaths.ResultsOver a median follow-up of 6.8 years, there were 164 deaths from any cause, 33 CVD-related deaths, 91 HF events, and 340 participants experienced the CVD composite. Adjusted HRs comparing the highest to lowest quartile of SD of HbA1C were 2.10 (95% CI 1.26 to 3.51), 3.43 (95% CI 0.95 to 12.38), 1.01 (95% CI 0.69 to 1.46), and 1.71 (95% CI 0.69 to 4.24) for all-cause mortality, CVD mortality, CVD composite and HF, respectively. The equivalent HRs for highest versus lowest quartile of SD of FPG were 1.66 (95% CI 0.96 to 2.85), 2.20 (95% CI 0.67 to 7.25), 0.94 (95% CI 0.65 to 1.35), and 2.05 (95% CI 0.80 to 5.31), respectively.ConclusionsA greater variability in HbA1C was associated with elevated risk of mortality. Our findings underscore the need to achieve normal and consistent glycemic control to improve clinical outcomes among individuals with type 2 diabetes.

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Association of the magnitude of weight loss and changes in physical fitness with long-term cardiovascular disease outcomes in overweight or obese people with type 2 diabetes: a post-hoc analysis of the Look AHEAD randomised clinical trial

The Lancet Diabetes & Endocrinology ◽

10.1016/s2213-8587(16)30162-0 ◽

2016 ◽

Vol 4 (11) ◽

pp. 913-921 ◽

Cited By ~ 183

Keyword(s):

Type 2 Diabetes ◽

Randomised Clinical Trial ◽

Obese People ◽

Post Hoc Analysis ◽

Disease Outcomes ◽

Look Ahead ◽

The Look ◽

Post Hoc

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Effect of a lifestyle intervention on change in cardiorespiratory fitness in adults with type 2 diabetes: results from the Look AHEAD Study

International Journal of Obesity ◽

10.1038/ijo.2008.280 ◽

2009 ◽

Vol 33 (3) ◽

pp. 305-316 ◽

Cited By ~ 83

Author(s):

J M Jakicic ◽

◽

S A Jaramillo ◽

A Balasubramanyam ◽

B Bancroft ◽

...

Keyword(s):

Type 2 Diabetes ◽

Lifestyle Intervention ◽

Cardiorespiratory Fitness ◽

Look Ahead ◽

The Look

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Changes in the Prevalence of Symptoms of Depression, Loneliness, and Insomnia in U.S. Older Adults With Type 2 Diabetes During the COVID-19 Pandemic: The Look AHEAD Study

10.2337/figshare.16814923.v1 ◽

2021 ◽

Author(s):

Ariana M. Chao ◽

Thomas A. Wadden ◽

Jeanne M. Clark ◽

Kathleen M. Hayden ◽

Marjorie J. Howard ◽

...

Keyword(s):

Type 2 Diabetes ◽

Older Adults ◽

Depressive Symptoms ◽

Study Data ◽

Symptoms Of Depression ◽

Look Ahead ◽

The Look ◽

Design And Methods ◽

Hispanic White

Objective: To evaluate changes in the prevalence of depressive symptoms, loneliness, and insomnia among older adults with type 2 diabetes from 2016 to 2020, and to assess risk factors for these conditions including demographics, multimorbidity, body mass index, treatment group, and pre-COVID-19 measure scores. Research Design and Methods: This was a prospective, observational study of participants from the Look AHEAD cohort study. Data were from two assessments before COVID-19 (Visit 1 (V1): April 2016-June 2018 and Visit 2 (V2): February 2018-February 2020), and one assessment during COVID-19 (Visit 3 (V3): July-December 2020). Surveys were administered to assess depressive symptoms, loneliness, and insomnia. Results: The study included 2829 adults (63.2% female, 60.6% white, mean [SD] age 75.6 [6.0] years). The prevalence of mild or greater depressive symptoms did not change significantly between the two pre-pandemic visits (p=0.88) but increased significantly from pre- to during COVID-19 (19.3% at V2 to 30.4% at V3 (p<0.001)). Higher odds of mild or greater depressive symptoms at V3 were associated with being female (adjusted odds ratio [OR]=1.4; 95% CI, 1.1-1.7), identifying as non-Hispanic White (OR=1.4; 95% CI, 1.1-1.7), having obesity (OR=1.3; 95% CI, 1.0-1.5), and reporting mild or greater depressive symptoms at Visit 1 (OR=4.0; 95% CI, 2.9-5.4), V2 (OR=4.4; 95% CI, 3.2-5.9), or both visits (OR=13.4; 95% CI, 9.7-18.4). The prevalence of loneliness increased from 12.3% at V1 to 22.1% at V3 (p<0.001), while the prevalence of insomnia remained stable across visits at 31.5-33.3%. Conclusions: The prevalence of mild or greater depressive symptoms in older adults with diabetes was more than 1.6 times higher during COVID-19 than before the pandemic.

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