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Diabetes weight loss programme ‘fails to cut CV risk’

A programme to reduce calorie intake and increase physical activity does not reduce the rate of cardiovascular events in overweight type 2 diabetes patients, a study has found.

The study

The US researchers studied 5,145 overweight and obese type 2 diabetes patients who were randomly assigned either a lifestyle intervention that promoted weight loss via reduced calorie intake and increased physical activity, or diabetes support and education (control group).  The primary outcome was a composite of death from cardiovascular causes, non-fatal myocardial infarction, non-fatal stroke, or hospitalisation for angina during a maximum follow-up of 13.5 years. Glycated haemoglobin levels were also measured.

The results

Weight loss was significantly greater in the intervention group than in the control group throughout the study (8.6% vs. 0.7% at one year; 6.0% vs. 3.5% at study end). Glycated haemoglobin levels in the intervention group were also signficantly lower in the intervention group, compared with the control group - 0.6% lower than that of the control group at one year, and were 0.2% lower than the control group at the 10-year point. But there was no significant difference in the primary outcome between groups, with 403 patients in the intervention group and 418 in the control group (1.83 and 1.92 events per 100 person-years) with this outcome recorded at the end of the study.

What this means for GPs

The researchers note that ‘lifestyle intervention did not reduce the risk of cardiovascular morbidity and mortality, as compared with a control programme of diabetes support and education’ but noted that patients in the intervention group had ‘clinically meaningful’ improvements in glycated haemoglobin levels.

NEJM, online June 2013


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