Intensive lifestyle intervention may increase the risk for cardiovascular disease, or CVD, for patients with type 2 diabetes (T2D), overweight or obesity, and poor glucose control, according to a study published in Diabetes Care. Investigators randomly assigned 5,145 participants (aged 45-76) with T2D and overweight or obesity to either 10 years of intensive lifestyle intervention or a control condition of diabetes support and education. Cardiovascular outcomes were compared among diabetes subgroups. The study team found 821 events for the primary cardiovascular outcome (first occurrence of a composite outcome that included death from cardiovascular causes, nonfatal myocardial infarction, and nonfatal stroke) during a median 9.4 years of follow-up. The lifestyle intervention had differential effects on cardiovascular outcomes depending on a patient’s diabetes subgroup at baseline, with an unadjusted incidence rate for the primary outcome of 18.9 per 1,000 person-years for older onset of diabetes, 23.6 for poor glucose control, 18.2 for severe obesity, and 15.7 for younger onset of diabetes. Among individuals in the poor glucose control diabetes subgroup (14% of the cohort), the lifestyle intervention was associated with an 85% greater risk for the primary cardiovascular outcome, as well as a greater risk for each of the secondary cardiovascular outcomes.
