Cardiometabolic benefits in people with obesity and type 2 diabetes | 12 OCT 22
Intensive workplace lifestyle therapy has profound cardiometabolic benefits in people with obesity and type 2 diabetes
• Intensive Lifestyle Therapy (ILT) in the workplace causes marked weight loss.
• ILT significantly improves β-cell function and multiorgan insulin sensitivity.
• Metabolic effects are associated with changes in the biology of muscle and adipose tissue.
The increase in the prevalence of obesity in recent decades has led to a significant increase in the prevalence of type 2 diabetes (T2D). Consequently, T2D has become a major global public health problem due to its causal relationship with serious medical complications, adverse effects on physical function, and significant economic impact associated with increased health care costs and reduced productivity.
Lifestyle therapy consisting of reduce dietary energy intake and increase physical activity with concomitant weight loss is the cornerstone of treatment for patients with obesity and T2DM. Weight loss has a dose-dependent therapeutic effect on metabolic function and glycemic control in people with prediabetes and T2D. In addition, remission of diabetes (HbA1c < 6.5%) without diabetes medication often occurs after 15% to 20% weight loss in those without long-standing T2D or severe cellular dysfunction.
Regular exercise, especially a combination of resistance exercise, is an important component of lifestyle therapy in people with T2D because it has therapeutic effects on glycemic control that are independent of weight loss.
Providing an effective lifestyle intervention is often challenging due to the limited availability of evidence-based programs, high cost, and inconvenience to participants.
The work environment offers a unique opportunity for lifestyle therapy because it can reduce or eliminate many of these barriers and further improve compliance by providing the social support associated with a group setting.
Although a systematic review of workplace-based weight loss programs and subsequent individual studies found that workplace interventions resulted in moderate weight loss and no program achieved the large weight loss required to induce diabetes remission, most interventions in these studies were of low or moderate intensity and provided minimal supervision (contact less than once a month), and only one program included supervised exercise sessions. We are not aware of any studies evaluating the potential therapeutic effect of an intensive diet and supervised exercise intervention delivered in the workplace.
The purpose of the present study was to conduct an 8-month randomized controlled trial in obese and T2D subjects to determine the therapeutic effects of intensive lifestyle therapy (ILT) that included both dietary energy restriction and supervised physical training, performed in the workplace, compared to standard care (dietary and physical activity instructions as recommended by the American Diabetes Association guidelines [ADA]); American Diabetes Association, 2020).
Effects on (1) major factors involved in the pathogenesis of T2D (insulin sensitivity, β-cell function, and metabolic response to glucose uptake), (2) body composition, (3) function (cardiorespiratory fitness and muscle strength), ( 4) plasma concentrations of adipokines that can influence insulin action (adiponectin and plasminogen activator inhibitor-1 [PAI-1]) and (5) potential cellular mechanisms putatively affecting insulin action (skeletal muscle gene expression profile and mitochondrial function and adipose tissue expression of genes involved in extracellular matrix formation and inflammation [ECM]).
We hypothesized that the improvement in whole-body insulin sensitivity (primary outcome) and all major factors involved in the pathogenesis of T2D (secondary outcomes) would be much greater in the ILT group than in the standard care (SC) group. .
Lifestyle therapy (restriction of energy and exercise) is the cornerstone of therapy for people with type 2 diabetes (T2D), but is difficult to implement. We conducted a randomized controlled trial of Eight months in people with obesity and T2D (17 women and 1 man) to determine the therapeutic effects and potential mechanisms of intensive lifestyle therapy on cardiometabolic function.