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

We previously demonstrated that achieving and maintaining ≥7% weight loss at one 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. We evaluated 122 patients with DM and obesity (mean age 53.2±10.0 years, 68% females, 90.2% type 2, mean DM duration 9.1±8.6 years, mean BMI 38.4±5.2 kg/m²) who underwent 12 weeks of ILI. The total cohort lost in average 10.7±4.6 kg (-9.6%, p<0.001) after 12 weeks. At 1 year, they were divided into group A, who maintained <7% weight loss (47.5%), and group B, who maintained ≥7% weight loss (52.5%). At 15 years, average weight loss in the entire cohort was 8.6±11.9 Kg (-7.6%, p<0.001). Group A maintained an average weight loss of 3.9±6.5 kg (-3.6%) at 5 years, 3.8±9.4 kg (-3.9%) at 10 years and 3.8±10.0 kg (-4.0%) at 15 years. Group B maintained an average weight loss of 10.6±9.8 kg (-9.1%) at 5 years, 10.8±9.6 kg (-9.3%) at 10 years and 12.9±12.0 Kg (-11.0%) at 15 years. At 15 years, weight loss in group B remained significantly higher than in group A (p<0.001). In group A, A1C reduced from 7.5±1.4% to 6.7±0.9% at 12 weeks, but rebounded to 8.0±1.9% at 5 years and 10 years and was 7.9±1.8% at 15 years. In group B, A1C decreased from 7.3±1.1% to 6.3±0.8% at 12 weeks, and was 7.4±1.6% at 5 years, 7.2±1.4% at 10 years and 7.3±1.5% at 15 years (p=0.04 between groups). Both groups maintained significant improvements in LDL- and HDL-cholesterol at 15 years, but group A had significant worsening of their serum triglycerides. Both groups had nonsignificant changes in blood pressure at 15 years. In conclusion, ILI in real-world clinical practice that results in ≥7% weight loss at one year in patients with DM and obesity is associated with continued improvement in cardiometabolic outcomes at 15 years.