Reference

Background for this

study

Research
Question/Hypothesis
Sample Size
Duration of Study
Study Design

Outcome Variable
Measurement Tools
Key Findings
Key Limitations to
the Study

Key Conclusions

AUTHORS: Bertoni, A.G., Clark, J.M., Feeney, P., Yanovski,

S.Z., Bantle, J., Montgomery, B., Safford, M.M., Herman, W.H.,
Haffner, S., and the Look AHEAD Research Group. Suboptimal
Control of Glycemia, Blood-Pressure, and LDL Cholesterol in
Overweight Adults with Diabetes: The Look AHEAD Study.
Journal of Diabetes and Its Complications. 2008; 22(9):19.
Many previous studies have shown that these critical factors in a
diabetics health are goals that are seldom met. In other words,
most American diabetics have glycemia, blood pressure, and
LDL cholesterol levels that are way too high, as is documented
by multiple studies in the past.
These researchers objectives were twofold: one, to discover the
number of adult diabetics who actually have achieved the ADA
targets for glycemia, BP and LDL cholesterol control; and two, to
determine what the correlates were for those achievements.
5, 145 participants
Ages 45-74
BMI >/= 25
2001-2004
Multi-center randomized trial performed to determine whether
long-term weight loss, and increased physical fitness reduced
CVD in overweight and obese individuals with Type-II diabetes.
Logistic regression was used to analyze these cross-sectional data
to ascertain associations between participant characteristics and
attainment of risk-factor goals.
Participants sociodemographics were obtained by self-report and
included source of medical care, medications, and prior
cardiovascular disease.
The average of two seated BPs, obtained 30-seconds apart after
an initial 5-minute rest period, using a calibrated device
(Dynamap Pro 100) was recorded.
Control to ADA goal levels was modest (blood glucose, 45.8%;
BP, 51.5 %; LDL, 37.2%). Only 10.1% had all three factors under
optimal control.
Those least likely to have hemoglobin A1c <7% were the
youngest participants with the longest duration of diabetes. Other
significant correlates of poorer control included less education
and reporting a community health center as the usual source of
care. The researchers claim that their main limitations are those
inherent in a cross-sectional analysis of randomized trial
participants at baseline.
These findings should be understood within the larger context of
control of risk factors in this population that was substantially
better than those in several prior studies. The researchers claim
that their study is the first to demonstrate a differential
deleterious effect of the duration of diabetes on glycemic control
across age groups. Multifaceted interventions directed at health
care providers or new models of care (e.g., the chronic care

Editorial Comments

model) have had some success in improving the control of

multiple risk factors among patients with diabetes. Further
attention on overcoming barriers for the achievement of more
aggressive risk factor target levels is needed.
I believe that this study would have more solid results if it did not
rely so heavily on self-reporting of participants, since human
beings tend to lie, exaggerate, or embellish the facts to make
themselves look better. It might also be more appropo to list
the results, increases and decreases in test figures, under specific
demographics, i.e., age, race, ethnicity, etc, in a more readable
figure format, such as a table that clearly demonstrates the
results. I had to read and reread many sentences and paragraphs,
and the tables were nearly undecipherable being so over-laden
with statistical data given in either statistical symbols or
percentages, without identifying percentage of what. In the first
table, they used both raw numbers and percentages; the other
tables did not follow suit. It would have been helpful if all of
their tables followed the same formatting. In addition, in their
discussion, the researchers discussed many elements that could
have influenced the results that they either did not control for, or
that were simply not incuded in the study. The researchers took a
very broad look at three specific factors in the control of diabetes,
and used a control-base that was almost overly diverse, which
may account for some of the confusing data featured in the
results-tables.