The Look AHEAD trial, evaluating the e
ffects o
f weight loss on cardiovascular (CV) morbidity and mortality in overweight/obese people with type 2 diabetes (T2D), was interrupted a
fter a median 9.5-year
follow-up because the incidence o
f CV events was not di
fferent between the Intensive Li
festyle Intervention (ILI) and the control groups, and unlikely to statistically change therea
fter. This made health providers and patients wondering about clinical value o
f diet and physical exercise in diabetic patients. Many
factors may have made di
fficult to ascertain bene
fits o
f li
festyle intervention, besides the lower than predicted CV event rates. Among others, LDL-cholesterol was lowered more, with a higher use o
f statins, in the control group. Anyhow, ILI signi
ficantly improved numerous health conditions, including quality o
f li
fe, CV risk
factors and blood glucose control, with more diabetes remissions and less use o
f insulin.
The intervention aimed at weight loss by reducing fat calories, and using meal replacements and, eventually, orlistat, likely underemphasizing dietary composition. There is suggestive evidence, in fact, that qualitative changes in dietary composition aiming at higher consumption of foods rich in fiber and with a high vegetable/animal fat ratio favorably influence CV risk in T2D patients.
In conclusion, the Look AHEAD showed substantial health benefits of lifestyle modifications. Prevention of CV events may need higher attention to dietary composition, contributing to stricter control of CV risk factors. As a better health-related quality of life in people with diabetes is an important driver of our clinical decisions, efforts on early implementation of behavioral changes through a multifactorial approach are strongly justified.