Skill Checkup: A 36-Year-Old Man With Type 2 Diabetes Is Struggling to Lose Weight

Anne L. Peters, MD; Romesh Khardori, MD, PhD


February 23, 2023

The Look AHEAD trial had, as its primary endpoint, a reduction in cardiovascular events. Although the study did not show that the intensive lifestyle intervention reduced cardiovascular events in adults with type 2 diabetes and overweight or obesity, it did confirm several beneficial effects of intensive lifestyle intervention. First, it confirmed the feasibility of achieving and maintaining long-term weight loss in patients with type 2 diabetes. In the intensive lifestyle intervention group, mean weight loss was 4.7% at 8 years. Approximately 50% of intensive lifestyle intervention participants lost and maintained ≥ 5% of their initial body weight; and about 27% lost and maintained ≥ 10% of their initial body weight at 8 years; in these patients, a reduction in cardiovascular endpoints was seen. Participants assigned to the intensive lifestyle group required fewer glucose-, blood pressure–, and lipid-lowering medications than those randomly assigned to standard care.

It is determined that the patient's antihyperglycemic therapy should be intensified by adding another antihyperglycemic agent that also reduces cardiovascular event risk and may produce weight loss.


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