ADA 2023: Long-Term Effects of Intensive Lifestyle Intervention in Real-World Clinical Practice on Cardiometabolic Outcomes in Patients with Diabetes–A 15-Year Longitudinal Study

Khater A, Al-Badr M, Salah T et al.

Studies in the past have shown that achieving and maintaining ≥7% weight loss at one year in patients with diabetes (DM) by means of multidisciplinary intensive lifestyle intervention (ILI) in real-world clinical practice can help predict improvement in cardiometabolic outcomes at 5 and 10 years.

A prospective follow-up, the authors reported the 15-year results of 122 patients with DM and obesity (mean age 53.2±10.0 years, 68% females, 90.2% type 2 DM, mean DM duration 9.1±8.6 years, mean BMI 38.4±5.2 kg/m²) who underwent 12 weeks of ILI.

At the end of 12 weeks, the total cohort lost on average 10.7±4.6 kg (-9.6%, p<0.001). At 1 year follow-up, the participants were categorized into two groups: group A, subjects who maintained less than 7% weight loss (47.5%), and group B, subjects who maintained a weight loss of 7% or more (52.5%). At 15 years, average weight loss in the entire cohort was 8.6±11.9 Kg (-7.6%, p<0.001). An average weight loss of 3.9±6.5 kg (-3.6%) at 5 years, 3.8±9.4 kg (-3.9%) at 10 years and 3.8±10.0 kg (-4.0%) at 15 years was maintained by Group A. In group B, an average weight loss of 10.6±9.8 kg (-9.1%) at 5 years, 10.8±9.6 kg (-9.3%) at 10 years and 12.9±12.0 Kg (-11.0%) at 15 years was maintained. Group B had significantly higher weight loss than group A at 15 years (p<0.001).

At 12 weeks, the HbA1C reduced from 7.5±1.4% to 6.7±0.9% in group A; however it went back to 8.0±1.9% at 5 years and 10 years and at 7.9±1.8% at 15 years. At 12 weeks, group B had HbA1C decreased from 7.3±1.1% to 6.3±0.8%; it was 7.4±1.6% at 5 years, 7.2±1.4% at 10 years and 7.3±1.5% at 15 years (p=0.04 between groups).

At 15 years, while both groups maintained significant improvements in LDL- and HDL-cholesterol, group A showed significant worsening of serum triglycerides. Both groups had nonsignificant changes in blood pressure at 15 years.

The study demonstrated that ILI in real-world clinical practice that results in ≥7% weight loss at 1 year in patients with DM and obesity is associated with continued improvement in cardiometabolic outcomes at 15 years.

441-P. American Diabetes Association (ADA) 83rd Scientific Sessions, 2023, 23- 25 June 2023, San Diego, CA.