October 08, 2019
A relatively modest amount of weight loss within the first year of being diagnosed with type 2 diabetes more than doubles the likelihood that patients will be in remission at 5 years, compared with those whose weight remains stable or who gain weight, a new prospective cohort study from the UK indicates.
"Existing evidence for achieving remission suggests extreme levels of exercise and restrictive diets" are required, lead author Hajira Dambha-Miller, MRCGP, PhD, clinical lecturer in general practice, University of Cambridge, UK, told Medscape Medical News.
But in this study, "All our participants did different things and [some] still managed to lose weight and achieve remission, so the key message here is that modest amounts of weight change without any extreme dieting or physical activity can result in remission," she stressed.
"I am a general practitioner and treat patients with type 2 diabetes on a regular basis," and intensive lifestyle interventions with extreme diets are “simply not realistic or achievable for my patients, especially in the longer-term,” she said in an e-mail.
Indeed, the researchers found that 10% weight loss was enough to induce remission in many cases, Dambha-Miller and colleagues explain in their article, published online in Diabetic Medicine.
"There could be a window of opportunity following diagnosis when people might be more receptive to interventions concerning weight loss. Greater attention should be paid to enabling people to achieve weight loss following diagnosis of type 2 diabetes," they stress.
Prior Studies of Extreme Calorie Restriction
A number of prior studies have shown that type 2 diabetes can be reversed using extremely low calorie diets of under 1000 calories/day for up to a few months.
For example, in the Diabetes Remission Clinical Trial (DiRECT), liquid meal replacement of 850 calories/day for 3 to 5 months, followed by food reintroduction for 2 to 8 weeks and structured support for long-term weight loss maintenance, led to remission of type 2 diabetes in 36% of patients in the intervention arm at 2 years compared with just 3% of those in the control arm (P < .0001).
"Other studies with similar intensive interventions in highly selected populations include the Counterbalance trial and Look AHEAD trial," note Dambha-Miller and colleagues.
"Whilst our observational findings are consistent with these trials, the specific amount of weight loss required to achieve remission varies. Most previous studies advocate significant weight loss (> 15%), with the DiRECT, Counterbalance, and Look AHEAD trials reporting between 5- and 20-kg weight loss in order to achieve diabetes remission," they note.
"Our results suggest that more modest weight loss of > 10% is associated with a higher likelihood of remission if this occurs early in the disease trajectory," they emphasize.
A Window of Opportunity in the Few Years After Diagnosis
For their study, Dambha-Miller and colleagues took participants from the ADDITION-Cambridge population-based study: 867 participants aged 40-69 years with newly diagnosed type 2 diabetes. The mean age of those included in the analysis was 61 years, 61% were men, and 97% were white.
Weight, indices of physical activity, and diet and alcohol consumption were measured at baseline and again at 1 year, and remission rates at 5 years were calculated. Remission was defined as an A1c level < 6.5% (< 48 mmol/mol) in the absence of any diabetes medication or bariatric surgery.
Of the 867 participants included at baseline, 730 (84%) had weight and A1c measures at the 5-year follow-up and were included in the analysis.
At 5 years of follow-up, 30% of the cohort had achieved remission.
"We found that weight loss of ≥ 10% in the first few years after diagnosis was strongly associated with remission of type 2 diabetes at 5 years," write the researchers.
Participants who lost 10% or more of their body weight out to 5 years were almost 2.5 times more likely to be in remission than those whose weight had remained stable or increased, at a risk ratio of 2.43 (P < .01).
Indeed, even weight loss of ≥ 5% to < 10% was associated with a higher likelihood of remission out to 5 years (risk ratio, 1.43; P = .02) compared with those whose weight didn't change or increased.
Most importantly, type 2 diabetes remission was achieved without the need for extreme calorie restrictions or intensive lifestyle intervention, the authors reiterate.
These results "suggest that patients can take advantage of a range of approaches to help them lose weight since there were no specific dietary or physical activity instructions for participants to achieve a 10% or greater loss in body weight," they note.
"This means that the study is generalizable to wider diabetes populations outside clinical trial cohorts," they state.
"This may provide some rationale for motivating people with newly diagnosed type 2 diabetes to lose weight rather than focusing on specific and potentially unachievable weight targets," the authors conclude.
Type 2 Diabetes Remission a Practical Target for Primary Care
Asked by Medscape Medical News to comment on the findings, Mike Lean, MD, University of Glasgow, UK, an author on the DiRECT trial, said the current study offers "a good piece of extra information confirming the reversibility of type 2 diabetes."
It also underscores how important it is to treat patients with type 2 diabetes "with substantial weight loss as soon as possible" after diagnosis, he added.
Indeed, as results from DiRECT suggest, the more weight a patient can lose, the greater the likelihood they will successfully achieve remission, Lean and coauthors said.
"Remission of type 2 diabetes is a practical target for primary care," they concluded.
Dambha-Miller and Lean have reported no relevant financial relationships.