Effects of a long-term lifestyle modification programme on peripheral neuropathy in overweight or obese adults with type 2 diabetes: the Look AHEAD study

Autor: David Lefkowitz, Steven E. Kahn, Mary Evans, Robert W. Jeffery, Monika M. Safford, John P. Foreyt, Karen C. Johnson, Thomas A. Wadden, James O. Hill, Helmut Steinburg, Mace Coday, Anne Kure, Helen P. Hazuda, Judith G. Regensteiner, Ping Zhang, Michelle E. Fisher, Haiying Chen, Mary T. Korytkowski, Henry J. Pownall, George A. Bray, Jeanne M. Clark, Maria G. Montez, Jeffrey M. Curtis, Edward W. Gregg, George L. Blackburn, Rena R. Wing, Barbara J. Maschak-Carey, John M. Jakicic, Jennifer Patricio, Xavier Pi-Sunyer, William C. Knowler, David M. Nathan, Bruce Redmon, Edward S. Horton, Anne L. Peters, Sara Michaels, Frank L. Greenway, Jeanne Charleston, Judy Bahnson
Rok vydání: 2016
Předmět:
Male
medicine.medical_specialty
Sensory Receptor Cells
Endocrinology
Diabetes and Metabolism
030209 endocrinology & metabolism
Type 2 diabetes
Overweight
Article
1117 Public Health and Health Services
Body Mass Index
03 medical and health sciences
Endocrinology & Metabolism
0302 clinical medicine
Lifestyle modification
Surveys and Questionnaires
Weight Loss
Internal Medicine
medicine
Humans
Obesity
Aged
Weight regulation and obesity
Science & Technology
business.industry
Look AHEAD Research Group
Peripheral Nervous System Diseases
1103 Clinical Sciences
Middle Aged
medicine.disease
Clinical diabetes
3. Good health
Term (time)
Peripheral neuropathy
Diabetes Mellitus
Type 2
Physical Fitness
Neuropathy-somatic
Physical therapy
POLYNEUROPATHY
1114 Paediatrics and Reproductive Medicine
Female
medicine.symptom
business
SEMMES-WEINSTEIN MONOFILAMENTS
Life Sciences & Biomedicine
Risk Reduction Behavior
030217 neurology & neurosurgery
Zdroj: Diabetologia
ISSN: 1432-0428
Popis: Aims/hypothesis The aim of this study was to evaluate the effects on diabetic peripheral neuropathy (DPN) of a long-term intensive lifestyle intervention (ILI) programme designed to achieve and maintain weight loss. Methods Beginning in 2001, a total of 5145 overweight or obese people with type 2 diabetes, aged 45–76 years, participating in the multicentre Look AHEAD (Action for Health in Diabetes) study were randomised to ILI (n = 2570) or to a diabetes support and education (DSE) control group (n = 2575) using a web-based management system at the study coordinating centre at Wake Forest School of Medicine (Winston-Salem, NC, USA). Randomisation was stratified by clinical centre and was not revealed to the clinical staff responsible for obtaining data on study outcomes. Because of the nature of the study, patients and the local centre interventionists were not blinded to the study group assignments. In addition, the coordinating centre staff members responsible for data management and statistical analyses were not blinded to the study group assignments. The interventions were terminated in September 2012, 9–11 years after randomisation, but both groups continued to be followed for both primary and secondary outcomes. Neuropathy evaluations included the Michigan Neuropathy Screening Instrument (MNSI) questionnaire completed at baseline in 5145 participants (ILI n = 2570, DSE n = 2575) and repeated annually thereafter and the MNSI physical examination and light touch sensation testing conducted in 3775 participants (ILI n = 1905, DSE n = 1870) 1–2.3 years after discontinuation of the intervention. Results At baseline, the MNSI questionnaire scores were 1.9 ± 0.04 and 1.8 ± 0.04 in the ILI and DSE groups, respectively (difference not statistically significant). After 1 year, when weight loss was maximal in the ILI group (8.6 ± 6.9%) compared with DSE (0.7 ± 4.8%), the respective MNSI scores were 1.7 ± 0.04 and 2.0 ± 0.04 (p ≤ 0.001). Subsequently, the scores increased gradually in both groups, but remained significantly lower in the ILI group for the first 3 years and at the end of follow-up. In both groups, there was a significant association between changes in the MNSI scores and changes in body weight, HbA1c and serum lipids. There were no significant between-group differences in the proportions of participants with MNSI physical examination scores ≥2.5, considered to be indicative of diabetic neuropathy. The light touch sensation measured separately in either the right or left big toes (halluces) did not differ between ILI and DSE, but when the data were combined for both toes, light touch was better preserved in the ILI group. Conclusions/interpretation ILI resulted in a significant decrease in questionnaire-based DPN, which was associated with the magnitude of weight loss. In both the ILI and DSE groups, changes in the MNSI score were also related to changes in HbA1c and lipids. There were no significant effects of ILI on physical examination measures of DPN conducted 1–2.3 years after termination of the active intervention, except for light touch sensation, which was significantly better in the ILI group when measurements were combined for both toes. However, a potential limiting factor to the interpretation of the physical examination data is that no baseline studies are available for comparison. Trial registration: ClinicalTrials.gov NCT00017953. Funding: This work was funded by the National Institutes of Health through cooperative agreements with the National Institute of Diabetes and Digestive and Kidney Diseases. Electronic supplementary material The online version of this article (doi:10.1007/s00125-017-4253-z) contains peer-reviewed but unedited supplementary material, which is available to authorised users.
Databáze: OpenAIRE
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