Action for Health in Diabetes (Look AHEAD) Extended Follow-up (LA-E2)

2型糖尿病在美国老年人中很常见，有2670万例 预计到2050年，将比2005年增长近4.5倍，其中绝大多数人 超重或肥胖。2型糖尿病和超重/肥胖通常被描述为生物学上的加速器 由于寿命缩短、残疾风险增加和健康相关质量降低而导致的老龄化 生活的一部分。然而，并不是所有患有这些疾病的人在晚年都面临同样的预后，有些人还会继续这样做。 保持相对较高的功能和独立性。这表明，可以确定战略。 以促进更健康的晚年生活体验。人们很自然地认为，行为干预是为了促进和 保持减肥可能会减轻衰老的后果。 为响应RFA-AG-21-028 Limited，我们建议进行展望扩展-2(LA-E2 为继续进行前瞻性研究而进行的竞争，该研究强调“评估重要的健康-- 在18年来被广泛描述的队列中，随着时间的推移而产生的相关结果 强调“与健康老龄化和复原力相关的结果；重大健康事件；医疗保健 利用；以及相关的行为和其他因素，预测、调解或以其他方式通知长期 多领域生活方式干预对老年减肥效果的影响 患有2型糖尿病的成年人。我们计划招募大约2600名前瞻性参与者 被随机分配到10年的密集生活方式干预中，成功地诱导和 保持体重减轻或糖尿病支持和教育的对照条件。这些人将成为 通过电话采访和医疗保险联系，又跟踪了4年，以评估这一遗留问题 对重要的晚年结果进行干预。 RFA针对五个方面的结果：1)多病，2)身体功能，3)认知功能，4) 卫生保健利用和费用；5)与健康相关的生活质量和健康状况。这些目标和 结果构成了我们的主要目标。我们也有重要的次要目标，正如《气候变化框架协议》所规定的那样，要研究。 糖尿病和慢性疾病发展的异质性在这项具有良好特征的、多样化的研究中 人口。“我们将描述晚年生活结果如何与临床措施、药物使用、 和行为，以及干预效果在不同性别、种族/民族的个人之间有何不同， 年龄、肥胖和健康状况。我们还将保持展望队列作为发现的来源，通过 促进辅助研究、传播和分发有据可查的公共使用数据；以及 通过科学利益集团。 我们的首要目标是提供对改善老年类风湿患者护理至关重要的信息 2糖尿病和超重或肥胖。

Type 2 diabetes mellitus is common among older individuals in the United States, with 26.7 million cases projected by 2050, an almost 4.5-fold increase from 2005, and the vast majority of these individuals have overweight or obesity. Type 2 diabetes and overweight/obesity are often described as accelerators of biological aging due to associations with decreased lifespan, increased disability risk, and reduced health-related quality of life. Yet, not all individuals with these conditions face the same prognosis in later life, and some continue to maintain relatively high levels of function and independence. This suggests that strategies could be identified to promote healthier later-life experiences. It is natural to consider that behavioral intervention to promote and maintain weight loss may mitigate against the consequences of aging. We propose to conduct the Look AHEAD Extension-2 (LA-E2) in response to RFA-AG-21-028 Limited Competition for the Continuation of the Look AHEAD Study, which emphasizes “assessing important health- related outcomes over time” in a cohort that has been extensively characterized over 18 years, with an emphasis on “outcomes that are relevant to healthy aging and resilience; major health events; healthcare utilization; and relevant behavioral and other factors that predict, mediate, or otherwise inform the long-term health effects of a multi-domain lifestyle intervention designed to produce and maintain weight loss in aging adults with type 2 diabetes mellitus.” We plan to enroll approximately 2600 Look AHEAD participants who had been randomly assigned to 10 years of either Intensive Lifestyle Intervention that successfully induced and maintained weight loss or a comparator condition of Diabetes Support and Education. These individuals will be followed for 4 additional years, using telephone interviews and Medicare linkage, to assess the legacy of this intervention on important later-life outcomes. The RFA targets five domains of outcomes: 1) Multimorbidity, 2) Physical function, 3) Cognitive function, 4) Health care utilization and costs, and 5) Health related quality of life and health status. These goals and outcomes frame our primary aims. We also have important secondary aims, as specified in the RFA, “to study the heterogeneity of diabetes and chronic disease development in this well-characterized, diverse study population.” We will describe how later-life outcomes are associated with clinical measures, medication use, and behaviors and how intervention effects vary among individuals depending on their gender, race/ethnicity, age, obesity, and health status. We will also maintain the Look AHEAD cohort as a source of discovery by promoting ancillary studies, dissemination, and the distribution of well-documented public use data, and through scientific interest groups. Our overarching goal is to provide information that is vital for improving the care of older individuals with type 2 diabetes mellitus and overweight or obesity.