Diet, exercise for Type 2 diabetics may not lower heart attack risk
Weight loss will not help lower the risk of heart attack and strokes for patients with Type 2 diabetes, a new study published Monday in the New England Journal of Medicine stated.
The study, which was also presented at the American Diabetes Association 2013 Scientific Sessions in Chicago, revealed that while getting rid of extra pounds could improve physical quality of life, reduce some blood vessel complications, lower the risk of depression and even decrease medical costs -- weight loss did not bring major heart benefits.
Currently 25.8 million children and adults in the U.S. have diabetes, according to the American Diabetes Association. Type 2 diabetes is the most common form of the disease. People who have the disease do not produce enough insulin, or their cells ignore the insulin in their body. Insulin helps the body use sugars, called glucose, for energy.
Study participants came from the Look AHEAD (Action for Health in Diabetes) trial, which involved more than 5,000 overweight and obese adults between 45 and 75 who had Type 2 diabetes. The subjects were either instructed to change their lifestyle through weight loss and physical activity or through diabetes support and education, which involved three counseling sessions per year on nutrition, physical activity and social support. Patients were followed up with for up to 11.5 years, with a median period of 9.6 years.
Patients in the weight loss group initially lost 8.6 percent of their body weight, and were able to maintain a 6 percent weight loss at the end of the study. However, they did not reduce their risk of cardiovascular illness or death rates, or their levels of "bad" LDL-cholesterol compared to the other support and education group.
In comparison, the support and education group lost 0.7 percent of their body weight at the beginning, and were able to keep of 3.5 percent at the end of the study.
"We are interested in following Look AHEAD participants over time to see if this nonsignificant effect increases or decreases over time," author Rena Wing, Professor of Psychiatry & Human Behavior at Brown University in Providence, R.I., said at a press conference according to MedPage Today. "I think that will be one of the important things to follow over time."
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But, weight loss benefits shouldn't be written off. The authors noted that the study cannot prove that weight loss has no benefits against heart attack and stroke, and that there may have been a case of more medication use in the diet and exercise group that would have lowered the LDL level to that of the education group.
In addition, the lifestyle group did reduce their risk of kidney disease, self-reported retinopathy (damage to the retina of the eye) and depression. They also had a greater improvement in their quality of life, fitness and lowered their annual hospital rates and costs. The subjects also lower blood glucose levels and lowered their risk of other cardiovascular disease factors.
"This study shows that overweight and obese adults with Type 2 diabetes can lose weight and keep it off with many important health benefits," Dr. Griffin P. Rodgers, director of the National Institute of Diabetes and Digestive and Kidney Diseases, part of the National Institutes of Health, which funded the study, said in a press release. "It reinforces the recommendation that overweight and obese people with Type 2 diabetes should increase their physical activity levels and lose weight to improve their health."
Gary Foster, director of the Center for Obesity Research and Education at Temple University in Philadelphia, added to USA Today that the study also shows that people who were dedicated to weight loss could keep off the pounds. He was also impressed with some of the other risk reductions.
"(Losing weight was) a pretty big bang for their buck. It looks like there are whopping effects on kidney disease," he said.
Another study released this week also showed exercise and lifestyle changes can boost health.
New research published June 25 in Radiology showed that moderate-intensity exercise was able to reduce fat stored around the heart, liver and abdomen in people with Type 2 diabetes. Researchers looked at the organ-specific fat collection and heart function of 12 patients (average age 46). They underwent MRI exams before and after six months of exercising, which included between 3.5 to 6 hours per week of two endurance and two resistance training sessions.
Fatty areas around abdomen, liver and around the heart -- all of which have been associated with increased cardiovascular risk -- were shown to be significantly reduced. The liver is especially important in controlling total body fat distribution, so losing fat around the organ can help reduce fats in other parts of the body.
"In the future, we hope to be able to use advanced imaging techniques to predict in individual patients which therapeutic strategy is most effective: Diet, medication, exercise, surgery or certain combinations," Dr. Hildo J. Lamb, from the Department of Radiology at Leiden University Medical Center in the Netherlands, said in a press release.
