Abstract 1300: Improvement in Glucose Control With Lifestyle Intervention Reduces C-Reactive Protein in Obese Subjects With Type 2 Diabetes: The Look AHEAD Study
Background: Obesity and poor glycemic control are associated with increased inflammation in persons with type 2 diabetes (T2DM). Lifestyle changes with weight loss have been associated with a decrease in high-sensitivity C-reactive protein (hs-CRP), a biomarker of the chronic inflammatory state. The association of glycemic control, achieved with modification of lifestyle behaviors, and hs-CRP in individuals with T2DM, has not been established.
Objective: To evaluate the impact of glucose control on hs-CRP in a subset of 1759 Look AHEAD participants who had levels obtained at baseline and at a year after intervention. Look AHEAD is a multicenter randomized clinical trial designed to examine whether a behavioral lifestyle intervention targeting weight loss through improvements in diet and physical activity levels will reduce cardiovascular events in overweight/obese subjects with T2DM.
Methods: Subjects were randomized to one of two arms: intensive lifestyle intervention (ILI) or diabetes support and education (DSE). Variable changes between arms were evaluated. Change in log hs-CRP was analyzed using multivariable regression analysis, with changes in BMI and HbA1c as predictors, adjusting for change in fitness, intervention effect, age, gender, race/ethnicity, history of cardiovascular disease, smoking, statin and thiazolidinedione use. BMI and HbA1c were also evaluated in separate models.
Results: Baseline median hs-CRP was 4.2 mg/L (IQR 7.0). ILI significantly decreased hs-CRP (−1.24 vs. −0.35 mg/L), weight (−9.0±7.6 vs. −0.8±5.0 kg), BMI (−3.2±2.6 vs. −0.3±1.8 kg/m2), and HbA1c (−0.7±1. vs −0.2±0.9%) when compared to DSE (p ±0.0001 for differences). One-year changes in BMI and in HbA1c independently predicted change in log hs-CRP (R2=0.11 and 0.10, respectively; p<0.0001 for each). A 1 % change in HbA1c was associated with a 13 % change in log CRP, and a 1.0 kg/m2 reduction in BMI was associated with a change of 6.3%.
Conclusion: Improved glucose control achieved with changes in diet and physical activity behaviors is associated with a reduction in hs-CRP that is independent of weight loss. Follow-up results from the Look AHEAD study will determine if improvement in glucose control will be associated with decreased cardiovascular events.