Long-Term Effects of Intensive Lifestyle Intervention on Cardiometabolic Outcomes in Patients With Diabetes in Real-World Clinical Practice: A 15-Year Longitudinal Study.

INTRODUCTION: We previously demonstrated that achieving and maintaining ≥ 7% weight loss at 1 year in patients with diabetes (DM), through multidisciplinary intensive lifestyle intervention (ILI) in real-world clinical practice, predicts improvement in cardiometabolic outcomes at 5 and 10 years. In this prospective follow-up, we report 15-year results. METHODS: We evaluated 122 patients with DM and obesity (mean age 53.2 ± 10.0 years, 68% females, 90.2% type 2 DM, mean DM duration 9.1 ± 8.6 years, mean BMI 38.4 ± 5.2 kg/m2) who completed a 12-week ILI program. The cohort achieved an average weight loss of 10.7 ± 4.6 kg (-9.6%, p < 0.001) at 12 weeks and was divided into two groups at 1 year: group A, who maintained < 7% weight loss (47.5%) and group B, who maintained ≥ 7% weight loss (52.5%). RESULTS: At 15 years, the cohort maintained an average weight loss of 8.6 ± 11.9 kg (-7.6%, p < 0.001). Group B demonstrated superior sustained weight loss (12.9 ± 12.0 kg, -11.0%) compared to group A (3.8 ± 10.0 kg, -4.0%) with p < 0.001 between groups. A1C in group B improved from 7.3% ± 1.1% to 6.3% ± 0.8% at 12 weeks and remained at 7.3% ± 1.5% at 15 years, while group A's A1C increased from 6.7% ± 0.9% to 7.9% ± 1.8% (p = 0.04 between groups). Both groups maintained LDL- and HDL-cholesterol improvements, but group A experienced significant worsening of serum triglycerides. CONCLUSIONS: ILI in real-world clinical practice that results in ≥ 7% weight loss at 1 year in patients with DM and obesity is associated with continued improvement in cardiometabolic outcomes at 15 years.