Physical and Cognitive Function - Look AHEAD Ancillary Study

• Sponsor: Wake Forest University (Other)
• Overall Status: Completed
• CT.gov ID: NCT01410097
• Collaborator: Pennington Biomedical Research Center (Other), University of Colorado, Denver (Other), University of Tennessee (Other), University of Pittsburgh (Other), National Institute on Aging (NIA) (NIH)
• Enrollment: 1,089
• Locations: 4
• Arms: 2
• Actual Duration (Months): 72
• Patients Per Site: 272.3
• Patients Per Site Per Month: 3.8

Study Details

Study Description

Brief Summary

Obesity is associated with physical disability through both direct pathways (e.g., lower extremity pain, insufficient muscle strength) and indirect pathways (obesity-related comorbidities and inflammation). Furthermore, diabetes, a major obesity-related health condition, is associated with increased risk of disability and accelerated declines in physical and cognitive function. The investigators preliminary data suggest that intentional weight loss improves physical function, and there is strong circumstantial evidence that it would also benefit cognitive function.

To evaluate the role of intentional weight loss on physical and cognitive function, the investigators propose an ancillary study to the on-going Look AHEAD (Action for Health in Diabetes) trial. Look AHEAD is a multi-center, randomized clinical trial to examine the effects of a 4-year lifestyle intervention designed to achieve and maintain weight loss through decreased caloric intake and exercise in overweight or obese men and women aged 45-74 years with type 2 diabetes. The investigators propose to add validated and well-established measures of physical and cognitive performance to the year 8 follow-up visit - during the trial's weight maintenance phase - in ~1000 participants at 4 of the 16 Look AHEAD field sites (Colorado, Memphis, Pennington and Pittsburgh).

The specific aims of this ancillary study are: 1) To determine the long-term effects of a lifestyle intervention designed to achieve and maintain weight loss on physical function; and 2) To determine the long-term effects of a lifestyle intervention designed to achieve and maintain weight loss on cognitive function. In addition, the investigators hypothesize that in the intervention group, larger initial weight loss, better weight loss maintenance, and higher physical activity will be associated with better physical and cognitive function. The investigators also hypothesize that in the control group weight loss will be associated with worse physical and cognitive function than in those who are weight stable or who have gained weight.

The number of obese older adults is rising rapidly and there are few data to guide an evidence-based clinical response to their management. The results of this study will provide the first direct evidence of the role of long-term intentional weight loss on the maintenance of physical and cognitive function in older obese adults with diabetes. Since this study is being done as an ancillary study to an on-going trial it can be done in a timely and cost-efficient manner.

Condition or Disease	Intervention/Treatment	Phase
Diabetes; Weight Loss; Physical Function; Cognitive Function	Behavioral: Lifestyle intervention; Behavioral: Diabetes Support Education	N/A

Study Design

• Study Type: Interventional
• Actual Enrollment: 1089 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Masking: None (Open Label)
• Primary Purpose: Prevention
• Official Title: Intentional Weight Reduction and Physical and Cognitive Function - A Look AHEAD Ancillary Study
• Actual Study Start Date: Sep 1, 2009
• Actual Primary Completion Date: Sep 1, 2015
• Actual Study Completion Date: Sep 1, 2015

Arms and Interventions

Arm	Intervention/Treatment
Experimental: Lifestyle intervention Intensive Lifestyle Intervention that includes diet, physical activity, and behavior modification. The goal of the ILI intervention was for individuals to achieve and maintain a loss of at least 7% of initial body weight.	Behavioral: Lifestyle intervention; Intensive Lifestyle Intervention that includes diet, physical activity, and behavior modification. The goal of the ILI intervention was for individuals to achieve and maintain a loss of at least 7% of initial body weight.
Placebo Comparator: Diabetes Support and Education (DSE) It offers an educational program to participants including developing support groups. Providing such benefits helps retain these participants in the trial.	Behavioral: Diabetes Support Education; It offers an educational program to participants including developing support groups. Providing such benefits helps retain these participants in the trial.

Outcome Measures

Primary Outcome Measures

1. Short Physical Performance Battery (SPPB) Score [Assessed 8 or 9 years post-randomization in Look AHEAD parent Study]

   The Short Physical Performance Battery (SPPB) was administered to assess lower extremity physical performance and consisted of standing balance tasks (side-by-side, semi- and full-tandem stands for 10 seconds each), time to complete 5 repeated chair stands, and a 6-m walk to assess usual gait speed. Each of the three performance measures was assigned a score ranging from 0 (inability to perform the task) to 4 (the highest level of performance) and summed to create an SPPB score ranging from 0 to 12 (best). Assessed 8 or 9 years post-randomization in Look AHEAD parent Study.

Secondary Outcome Measures

1. Gait Speed Over 400 m [Assessed 8 or 9 years post-randomization in Look AHEAD parent Study]

   A 400 m walk was administered to assess endurance. Participants were instructed to walk at their usual pace and time to complete the 400-m walk was recorded. The 400-m walk test was terminated if the participant reported chest pain, tightness or pressure, significant shortness of breath or difficulty breathing, feeling faint, lightheaded or dizzy, or other pain (e.g., leg pain).Assessed 8 or 9 years post-randomization in Look AHEAD parent Study

2. Grip Strength [Assessed 8 or 9 years post-randomization in Look AHEAD parent Study]

   Grip strength (kg) was measured twice in each hand using an isometric Hydraulic Hand Dynamometer (Jamar, Bolingbrook, IL). The maximum of the force from two trials for the stronger hand was used in the analyses. Participants with severe hand pain or recent surgery in both hands were excluded from testing. Assessed 8 or 9 years post-randomization in Look AHEAD parent Study.

3. Knee Extensor Strength [Assessed 8 or 9 years post-randomization in Look AHEAD parent Study]

   Maximum knee extensor strength (one repetition maximum (1RM)) was assessed on a Nautilus One™ Leg Extension machine. Participants with prior knee surgery on both knees where all or part of the joint was replaced were excluded from testing. The right leg was tested unless there was a contraindication (e.g., prior knee surgery). If participants experienced knee pain during the test and there were no contraindications to test the other leg, the other leg was tested; if participants experienced knee pain on the other leg, the test was terminated. Assessed 8 or 9 years post-randomization in Look AHEAD parent Study

4. Trail Making Test (Part A & B) [Assessed 8 or 9 years post-randomization in Look AHEAD parent Study]

   Trail Making Tests A and B was used to assess attention and concentration (Part A) and executive function (Part B). Part A measures the time (in seconds) to draw lines to connect circled numbers in a numerical sequence and Part B measures the time (in seconds) to draw lines to connect circled numbers and letters in an alternating numeric and alphabetic sequence as rapidly as possible. The difference (in seconds; greater time indicates worse performance) in performance on Part B minus Part A was used in analysis to represent the contrast between performance on the simple (Part A) and alternating conditions (Part B). Assessed 8 or 9 years post-randomization in Look AHEAD parent Study.

5. Digit Symbol Substitution Test (DSST) [Assessed 8 or 9 years post-randomization in Look AHEAD parent Study]

   The Digit Symbol Substitution Test (DSST) was used to assess working memory. Participants were presented with a legend at the top of the page showing the boxes each with a number from 1 to 9 and below each numbered box is a unique symbol. As rapidly as possible, the participant fills in the randomly ordered boxes with numbers paired with blank boxes with the symbol that corresponds to the number in the legend. The score is the total number of correctly entered symbols completed in 90 seconds (range, 0-133; higher score indicates better performance). Assessed 8 or 9 years post-randomization in Look AHEAD parent Study.

6. Rey Auditory Verbal Learning Test (RAVLT) [Assessed 8 or 9 years post-randomization in Look AHEAD parent Study]

   The Rey Auditory Verbal Learning Test (RAVLT) was used to assess verbal memory. The participant is read a list of 15 words five times. After each time the list is given, the participant is asked to immediately recall as many words as possible. Following the fifth recall, an interference list is presented, after which the participant is asked to spontaneously recall words from the original list. After a 10-minute interval has passed, the participant is asked again to recall as many words as possible from the original list. The number of words correctly recalled on the delayed recall were used in the analysis (range, 0-15; higher number correct indicates better performance). Assessed 8 or 9 years post-randomization in Look AHEAD parent Study.

7. Modified Stroop Color and Word Test [Assessed 8 or 9 years post-randomization in Look AHEAD parent Study]

   The Modified Stroop Color and Word Test was used to assess executive function. The test measures a participant's ability to view complex visual stimuli and to respond to one stimulus dimension while suppressing response to another competitive stimulation. The participant first reads aloud words denoting colors printed in black ink (Subtest 1), then names aloud the color of blocks printed in colored ink (Subtest 2), and finally names aloud the color ink in which the words are printed in which are incongruent to the word (Subtest 3). The amount of time to complete each subtest and the number of errors are recorded and interference calculated as time to complete Subtest 3 - Subtest 1 + errors (lower interference scores indicate better cognitive performance). Assessed 8 or 9 years post-randomization in Look AHEAD parent Study.

8. Modified Mini-Mental Status Exam (3MS) [Assessed 8 or 9 years post-randomization in Look AHEAD parent Study]

   The Modified Mini-Mental Status Exam (3MS) was used to assess global cognitive function. Scores range from 0 to 100 with higher scores indicating better cognitive function. Assessed 8 or 9 years post-randomization in Look AHEAD parent Study.

Eligibility Criteria

Criteria

• Ages Eligible for Study: 45 Years to 74 Years
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Inclusion Criteria:

• The only inclusion criterion is that the participant is considered "active" at his/her Year 8 or Year 9 visit in the main study.

Exclusion Criteria:

• The only exclusion criterion is the person is not willing to participate in this ancillary study.

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	University of Colorado Health Sciences Center	Aurora	Colorado	United States	80045
2	Pennington Biomedical Research Center	Baton Rouge	Louisiana	United States	70801
3	University of Pittsburgh	Pittsburgh	Pennsylvania	United States	15203
4	The University of Tennessee-Memphis	Memphis	Tennessee	United States	38105

Sponsors and Collaborators

• Wake Forest University
• Pennington Biomedical Research Center
• University of Colorado, Denver
• University of Tennessee
• University of Pittsburgh
• National Institute on Aging (NIA)

Investigators

• Principal Investigator: Stephen B Kritchevsky, PhD, Wake Forest University Health Sciences

Study Documents (Full-Text)

None provided.

More Information

Publications

None provided.

• Responsible Party: Wake Forest University
• ClinicalTrials.gov Identifier: NCT01410097
• Other Study ID Numbers: IRB00008777; R01AG033087
• First Posted: Aug 4, 2011
• Last Update Posted: Sep 10, 2018
• Last Verified: Aug 1, 2018

• Studies a U.S. FDA-regulated Drug Product: No
• Studies a U.S. FDA-regulated Device Product: No
• Additional relevant MeSH terms: Weight Loss

Study Results

Participant Flow

Recruitment Details	Participants who enrolled in the main Look AHEAD study were eligible to participate in this ancillary study. Starting at year 8 clinic visits of the main study at 4 sites (Pennington, Denver, Pittsburgh, and Memphis) participants were asked if they would participate in this study (9/09-06/12). Those who agreed & consented were then enrolled.

Arm/Group Title	Lifestyle Intervention	Diabetes Support and Education (DSE)
Arm/Group Description	Intensive Lifestyle Intervention that includes diet, physical activity, and behavior modification. The goal of the ILI intervention was for individuals to achieve and maintain a loss of at least 7% of initial body weight. Lifestyle intervention: Intensive Lifestyle Intervention that includes diet, physical activity, and behavior modification. The goal of the ILI intervention was for individuals to achieve and maintain a loss of at least 7% of initial body weight.	It offers an educational program to participants including developing support groups. Providing such benefits helps retain these participants in the trial. Diabetes Support Education: It offers an educational program to participants including developing support groups. Providing such benefits helps retain these participants in the trial.
Period Title: Overall Study
STARTED	556	533
COMPLETED	551	530
NOT COMPLETED	5	3

Baseline Characteristics

Arm/Group Title	Intensive Lifestyle Intervention (ILI)	Diabetes Support and Education (DSE)	Total
Arm/Group Description	Intensive Lifestyle Intervention that includes diet, physical activity, and behavior modification. The goal of the ILI intervention was for individuals to achieve and maintain a loss of at least 7% of initial body weight.	Diabetes Support and Education offers an educational program to participants focusing on diet, physical activity, and social support (information on behavioral strategies are not presented).	Total of all reporting groups
Overall Participants	553	528	1081
Age (years) [Mean (Standard Deviation) ]
Mean (Standard Deviation) [years]	58.9 (6.8)	59.1 (6.7)	59.0 (6.8)
Sex: Female, Male (Count of Participants)
Female	314 56.8%	304 57.6%	618 57.2%
Male	239 43.2%	224 42.4%	463 42.8%
Race/Ethnicity, Customized (Count of Participants)
African American	110 19.9%	108 20.5%	218 20.2%
Non Hispanic White	401 72.5%	378 71.6%	779 72.1%
Other/multiple	42 7.6%	42 8%	84 7.8%

Outcome Measures

1. Primary Outcome

Title	Short Physical Performance Battery (SPPB) Score
Description	The Short Physical Performance Battery (SPPB) was administered to assess lower extremity physical performance and consisted of standing balance tasks (side-by-side, semi- and full-tandem stands for 10 seconds each), time to complete 5 repeated chair stands, and a 6-m walk to assess usual gait speed. Each of the three performance measures was assigned a score ranging from 0 (inability to perform the task) to 4 (the highest level of performance) and summed to create an SPPB score ranging from 0 to 12 (best). Assessed 8 or 9 years post-randomization in Look AHEAD parent Study.
Time Frame	Assessed 8 or 9 years post-randomization in Look AHEAD parent Study

Outcome Measure Data

Analysis Population Description

Only participants who attended the ancillary clinic visit and were able to do the SPPB were included in the analysis (n=954)

Arm/Group Title	Intensive Lifestyle Intervention (ILI)	Diabetes Support and Education (DSE)
Arm/Group Description	Intensive Lifestyle Intervention includes diet, physical activity, and behavior modification. The goal of the ILI intervention was for individuals to achieve and maintain a loss of at least 7% of initial body weight.	Diabetes Support and Education offers an educational program to participants focusing on diet, physical activity, and social support (information on behavioral strategies are not presented).
Measure Participants	486	468
Mean (Standard Error) [Score on a scale]	10.1 (1.9)	10.0 (2.1)

2. Secondary Outcome

Title	Gait Speed Over 400 m
Description	A 400 m walk was administered to assess endurance. Participants were instructed to walk at their usual pace and time to complete the 400-m walk was recorded. The 400-m walk test was terminated if the participant reported chest pain, tightness or pressure, significant shortness of breath or difficulty breathing, feeling faint, lightheaded or dizzy, or other pain (e.g., leg pain).Assessed 8 or 9 years post-randomization in Look AHEAD parent Study
Time Frame	Assessed 8 or 9 years post-randomization in Look AHEAD parent Study

Outcome Measure Data

Analysis Population Description

Only participants who attended the ancillary clinic visit and were able to complete the 400 m walk were included in the analysis (n=869)

Arm/Group Title	Intensive Lifestyle Intervention (ILI)	Diabetes Support and Education (DSE)
Arm/Group Description	Intensive Lifestyle Intervention includes diet, physical activity, and behavior modification. The goal of the ILI intervention was for individuals to achieve and maintain a loss of at least 7% of initial body weight.	Diabetes Support and Education offers an educational program to participants focusing on diet, physical activity, and social support (information on behavioral strategies are not presented).
Measure Participants	447	422
Mean (Standard Deviation) [m/sec]	1.07 (.19)	1.05 (.19)

3. Secondary Outcome

Title	Grip Strength
Description	Grip strength (kg) was measured twice in each hand using an isometric Hydraulic Hand Dynamometer (Jamar, Bolingbrook, IL). The maximum of the force from two trials for the stronger hand was used in the analyses. Participants with severe hand pain or recent surgery in both hands were excluded from testing. Assessed 8 or 9 years post-randomization in Look AHEAD parent Study.
Time Frame	Assessed 8 or 9 years post-randomization in Look AHEAD parent Study

Outcome Measure Data

Analysis Population Description

Only participants who attended the ancillary clinic visit and were able to do the grip strength test were included in the analysis (n=907)

Arm/Group Title	Intensive Lifestyle Intervention (ILI)	Diabetes Support and Education (DSE)
Arm/Group Description	Intensive Lifestyle Intervention includes diet, physical activity, and behavior modification. The goal of the ILI intervention was for individuals to achieve and maintain a loss of at least 7% of initial body weight.	Diabetes Support and Education offers an educational program to participants focusing on diet, physical activity, and social support (information on behavioral strategies are not presented).
Measure Participants	462	445
Mean (Standard Deviation) [kg]	31 (10.2)	30.7 (10.7)

4. Secondary Outcome

Title	Knee Extensor Strength
Description	Maximum knee extensor strength (one repetition maximum (1RM)) was assessed on a Nautilus One™ Leg Extension machine. Participants with prior knee surgery on both knees where all or part of the joint was replaced were excluded from testing. The right leg was tested unless there was a contraindication (e.g., prior knee surgery). If participants experienced knee pain during the test and there were no contraindications to test the other leg, the other leg was tested; if participants experienced knee pain on the other leg, the test was terminated. Assessed 8 or 9 years post-randomization in Look AHEAD parent Study
Time Frame	Assessed 8 or 9 years post-randomization in Look AHEAD parent Study

Outcome Measure Data

Analysis Population Description

Only participants who attended the ancillary clinic visit and were able to achieve maximum knee extensor strength (1RM) were included in the analysis (n=701)

Arm/Group Title	Intensive Lifestyle Intervention (ILI)	Diabetes Support and Education (DSE)
Arm/Group Description	Intensive Lifestyle Intervention includes diet, physical activity, and behavior modification. The goal of the ILI intervention was for individuals to achieve and maintain a loss of at least 7% of initial body weight.	Diabetes Support and Education offers an educational program to participants focusing on diet, physical activity, and social support (information on behavioral strategies are not presented).
Measure Participants	359	342
Mean (Standard Deviation) [kg]	23.4 (11.9)	23.4 (12.5)

5. Secondary Outcome

Title	Trail Making Test (Part A & B)
Description	Trail Making Tests A and B was used to assess attention and concentration (Part A) and executive function (Part B). Part A measures the time (in seconds) to draw lines to connect circled numbers in a numerical sequence and Part B measures the time (in seconds) to draw lines to connect circled numbers and letters in an alternating numeric and alphabetic sequence as rapidly as possible. The difference (in seconds; greater time indicates worse performance) in performance on Part B minus Part A was used in analysis to represent the contrast between performance on the simple (Part A) and alternating conditions (Part B). Assessed 8 or 9 years post-randomization in Look AHEAD parent Study.
Time Frame	Assessed 8 or 9 years post-randomization in Look AHEAD parent Study

Outcome Measure Data

Analysis Population Description

Only participants who attended the ancillary clinic visit and completed the cognitive battery were included in the analysis (n=978)

Arm/Group Title	Intensive Lifestyle Intervention (ILI)	Diabetes Support and Education (DSE)
Arm/Group Description	Intensive Lifestyle Intervention includes diet, physical activity, and behavior modification. The goal of the ILI intervention was for individuals to achieve and maintain a loss of at least 7% of initial body weight.	Diabetes Support and Education offers an educational program to participants focusing on diet, physical activity, and social support (information on behavioral strategies are not presented).
Measure Participants	499	479
Mean (Standard Deviation) [secs]	62.87 (46.14)	62.85 (46.34)

6. Secondary Outcome

Title	Digit Symbol Substitution Test (DSST)
Description	The Digit Symbol Substitution Test (DSST) was used to assess working memory. Participants were presented with a legend at the top of the page showing the boxes each with a number from 1 to 9 and below each numbered box is a unique symbol. As rapidly as possible, the participant fills in the randomly ordered boxes with numbers paired with blank boxes with the symbol that corresponds to the number in the legend. The score is the total number of correctly entered symbols completed in 90 seconds (range, 0-133; higher score indicates better performance). Assessed 8 or 9 years post-randomization in Look AHEAD parent Study.
Time Frame	Assessed 8 or 9 years post-randomization in Look AHEAD parent Study

Outcome Measure Data

Analysis Population Description

Only participants who attended the ancillary clinic visit and completed the cognitive battery were included in the analysis (n=978)

Arm/Group Title	Intensive Lifestyle Intervention (ILI)	Diabetes Support and Education (DSE)
Arm/Group Description	Intensive Lifestyle Intervention includes diet, physical activity, and behavior modification. The goal of the ILI intervention was for individuals to achieve and maintain a loss of at least 7% of initial body weight.	Diabetes Support and Education offers an educational program to participants focusing on diet, physical activity, and social support (information on behavioral strategies are not presented).
Measure Participants	499	479
Mean (Standard Deviation) [number correct]	41.61 (10.38)	41.14 (10.84)

7. Secondary Outcome

Title	Rey Auditory Verbal Learning Test (RAVLT)
Description	The Rey Auditory Verbal Learning Test (RAVLT) was used to assess verbal memory. The participant is read a list of 15 words five times. After each time the list is given, the participant is asked to immediately recall as many words as possible. Following the fifth recall, an interference list is presented, after which the participant is asked to spontaneously recall words from the original list. After a 10-minute interval has passed, the participant is asked again to recall as many words as possible from the original list. The number of words correctly recalled on the delayed recall were used in the analysis (range, 0-15; higher number correct indicates better performance). Assessed 8 or 9 years post-randomization in Look AHEAD parent Study.
Time Frame	Assessed 8 or 9 years post-randomization in Look AHEAD parent Study

Outcome Measure Data

Analysis Population Description

Only participants who attended the ancillary clinic visit and completed the cognitive battery were included in the analysis (n=978)

Arm/Group Title	Intensive Lifestyle Intervention (ILI)	Diabetes Support and Education (DSE)
Arm/Group Description	Intensive Lifestyle Intervention includes diet, physical activity, and behavior modification. The goal of the ILI intervention was for individuals to achieve and maintain a loss of at least 7% of initial body weight.	Diabetes Support and Education offers an educational program to participants focusing on diet, physical activity, and social support (information on behavioral strategies are not presented).
Measure Participants	499	479
Mean (Standard Deviation) [number correct]	7.51 (3.28)	7.30 (3.22)

8. Secondary Outcome

Title	Modified Stroop Color and Word Test
Description	The Modified Stroop Color and Word Test was used to assess executive function. The test measures a participant's ability to view complex visual stimuli and to respond to one stimulus dimension while suppressing response to another competitive stimulation. The participant first reads aloud words denoting colors printed in black ink (Subtest 1), then names aloud the color of blocks printed in colored ink (Subtest 2), and finally names aloud the color ink in which the words are printed in which are incongruent to the word (Subtest 3). The amount of time to complete each subtest and the number of errors are recorded and interference calculated as time to complete Subtest 3 - Subtest 1 + errors (lower interference scores indicate better cognitive performance). Assessed 8 or 9 years post-randomization in Look AHEAD parent Study.
Time Frame	Assessed 8 or 9 years post-randomization in Look AHEAD parent Study

Outcome Measure Data

Analysis Population Description

Only participants who attended the ancillary clinic visit and completed the cognitive battery were included in the analysis (n=978)

Arm/Group Title	Intensive Lifestyle Intervention (ILI)	Diabetes Support and Education (DSE)
Arm/Group Description	Intensive Lifestyle Intervention includes diet, physical activity, and behavior modification. The goal of the ILI intervention was for individuals to achieve and maintain a loss of at least 7% of initial body weight.	Diabetes Support and Education offers an educational program to participants focusing on diet, physical activity, and social support (information on behavioral strategies are not presented).
Measure Participants	499	479
Mean (Standard Deviation) [score on a scale]	39.17 (17.71)	38.47 (18.68)

9. Secondary Outcome

Title	Modified Mini-Mental Status Exam (3MS)
Description	The Modified Mini-Mental Status Exam (3MS) was used to assess global cognitive function. Scores range from 0 to 100 with higher scores indicating better cognitive function. Assessed 8 or 9 years post-randomization in Look AHEAD parent Study.
Time Frame	Assessed 8 or 9 years post-randomization in Look AHEAD parent Study

Outcome Measure Data

Analysis Population Description

Only participants who attended the ancillary clinic visit and completed the cognitive battery were included in the analysis (n=978)

Arm/Group Title	Intensive Lifestyle Intervention (ILI)	Diabetes Support and Education (DSE)
Arm/Group Description	Intensive Lifestyle Intervention includes diet, physical activity, and behavior modification. The goal of the ILI intervention was for individuals to achieve and maintain a loss of at least 7% of initial body weight.	Diabetes Support and Education offers an educational program to participants focusing on diet, physical activity, and social support (information on behavioral strategies are not presented).
Measure Participants	499	479
Mean (Standard Deviation) [Score on a scale]	92.25 (5.94)	92.19 (6.66)

Adverse Events

Time Frame	1-2 weeks
Arm/Group Title	Lifestyle Intervention		Diabetes Support and Education (DSE)
Arm/Group Description	Intensive Lifestyle Intervention that includes diet, physical activity, and behavior modification. The goal of the ILI intervention was for individuals to achieve and maintain a loss of at least 7% of initial body weight. Lifestyle intervention: Intensive Lifestyle Intervention that includes diet, physical activity, and behavior modification. The goal of the ILI intervention was for individuals to achieve and maintain a loss of at least 7% of initial body weight.		It offers an educational program to participants including developing support groups. Providing such benefits helps retain these participants in the trial. Diabetes Support Education: It offers an educational program to participants including developing support groups. Providing such benefits helps retain these participants in the trial.
All Cause Mortality
	Lifestyle Intervention		Diabetes Support and Education (DSE)
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	/ (NaN)		/ (NaN)
Serious Adverse Events
	Lifestyle Intervention		Diabetes Support and Education (DSE)
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	0/556 (0%)		0/533 (0%)
Other (Not Including Serious) Adverse Events
	Lifestyle Intervention		Diabetes Support and Education (DSE)
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	0/556 (0%)		0/533 (0%)

Limitations/Caveats

[Not Specified]

More Information

Certain Agreements

All Principal Investigators ARE employed by the organization sponsoring the study.

There is NOT an agreement between Principal Investigators and the Sponsor (or its agents) that restricts the PI's rights to discuss or publish trial results after the trial is completed.