title: Long-term effect of intensive lifestyle intervention on cardiovascular risk factors in patients with diabetes in real-world clinical practice: a 5-year longitudinal study.
abstract: OBJECTIVE
  We evaluated long-term impact of sustained weight loss versus weight regain on cardiovascular risk factors in real-world clinical practice.
  
  
  METHODS
  We evaluated 129 obese patients with diabetes enrolled in Weight Achievement and Intensive Treatment (Why WAIT) program, a 12-week clinical model of intensive lifestyle intervention. After 1 year, we divided participants into group A, who maintained <7% weight loss (47.3%) and group B (52.7%), who maintained ≥7% weight loss. We continued to follow them for a total of 5 years.
  
  
  RESULTS
  The total cohort lost 23.8 lbs (-9.7%) at 12 weeks and maintained -16.2 lbs (-6.4%) at 5 years (p<0.001). Group A maintained -8.4 lbs (-3.5%) and group B maintained -23.1 lbs (-9.0%) at 5 years. In group A, A1C decreased from 7.5±1.3% to 6.7±0.9% at 12 weeks but increased to 7.7±1.4% at 1 year and 8.0±1.9% at 5 years. In group B, A1C decreased from 7.4±1.2% to 6.4±0.9% at 12 weeks and rose to 6.8±1.2% at 1 year and 7.3±1.5% at 5 years. Despite weight regain, group A maintained improvement in low-density lipoprotein-cholesterol and high-density lipoprotein-cholesterol with worsening of serum triglycerides and no change in blood pressure (BP). Group B maintained improvement in lipid profile for 5 years and had significantly lower BP for 18 months.
  
  
  CONCLUSIONS
  Weight reduction in patients with diabetes can be maintained for 5 years and is predicted by patients' ability to maintain ≥7% weight loss at 1 year. A1C and triglycerides deteriorate with weight regain, while other lipid improvements are maintained. Sustained weight loss is associated with significantly lower A1C for 5 years and lowers BP for 18 months.
  
  
  BACKGROUND
  NCT01937845.
authors.affiliation: Joslin Diabetes Center, Harvard Medical School , Boston, Massachusetts , USA.
authors.forename: Osama
authors.initials: O
authors.lastname: Hamdy
authors.affiliation: Joslin Diabetes Center, Harvard Medical School , Boston, Massachusetts , USA.
authors.forename: Adham
authors.initials: A
authors.lastname: Mottalib
authors.affiliation: Joslin Diabetes Center, Harvard Medical School , Boston, Massachusetts , USA.
authors.forename: Amr
authors.initials: A
authors.lastname: Morsi
authors.affiliation: Joslin Diabetes Center, Harvard Medical School , Boston, Massachusetts , USA.
authors.forename: Nuha
authors.initials: N
authors.lastname: El-Sayed
authors.affiliation: Joslin Diabetes Center, Harvard Medical School , Boston, Massachusetts , USA.
authors.forename: Ann
authors.initials: A
authors.lastname: Goebel-Fabbri
authors.affiliation: Joslin Diabetes Center, Harvard Medical School , Boston, Massachusetts , USA.
authors.forename: Gillian
authors.initials: G
authors.lastname: Arathuzik
authors.affiliation: Joslin Diabetes Center, Harvard Medical School , Boston, Massachusetts , USA.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Shahar
authors.affiliation: Joslin Diabetes Center, Harvard Medical School , Boston, Massachusetts , USA.
authors.forename: Amanda
authors.initials: A
authors.lastname: Kirpitch
authors.affiliation: Joslin Diabetes Center, Harvard Medical School , Boston, Massachusetts , USA.
authors.forename: John
authors.initials: J
authors.lastname: Zrebiec
keywords: Cardiovascular Disease Risk; Lifestyle Intervention(s); Weight Management