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Severe hypoglycemia in the Look AHEAD Trial
1Pennington Biomedical Research Center, Louisiana State University System, 6400 Perkins Road, Baton Rouge, LA 70808.
Journal of Diabetes and Its Complications
|April 27, 2016
Summary
Intensive lifestyle intervention in the Look AHEAD trial did not increase severe hypoglycemia overall. However, early intensive weight loss required insulin reduction to prevent hypoglycemia, especially in the first year.
Area of Science:
- Endocrinology
- Cardiovascular Medicine
- Diabetes Management
Background:
- The Look AHEAD trial investigated the impact of weight loss on cardiovascular outcomes in overweight individuals with type 2 diabetes.
- Severe hypoglycemia is a potential complication of diabetes management, particularly with intensive interventions.
Purpose of the Study:
- To evaluate the incidence of severe hypoglycemia in participants of the Look AHEAD trial.
- To compare severe hypoglycemia rates between an intensive lifestyle intervention (ILI) and diabetes support and education (DSE) groups.
Main Methods:
- A multi-center, randomized controlled trial involving 5,145 overweight individuals with type 2 diabetes.
- Participants were randomized to either DSE or ILI.
- Instances of severe hypoglycemia were recorded and analyzed using regression analysis.
Main Results:
- Overall severe hypoglycemia rates were similar between ILI and DSE groups (0.49 vs. 0.51 per 100 person-years).
- However, ILI showed a higher rate in year 1 (p=0.008).
- Severe hypoglycemia risk was higher with baseline insulin, sulfonylurea, or glitinide use (p<0.0001), and intervention effects varied by post-randomization insulin use.
Conclusions:
- Reducing insulin dosage is crucial during intensive weight loss to prevent hypoglycemia.
- Greater weight loss in the ILI group during year 1 was associated with reduced insulin use and lower subsequent hypoglycemia rates.
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