Remission of T2DM is possible without extreme lifestyle intervention in general population
Behaviour change, weight loss and remission of Type 2 diabetes: a community‐based prospective cohort studyLiterature - Dambha-Miller H, Day AJ, Strelitz J et al., - Diabet Med. 2019. https://doi.org/10.1111/dme.14122
Introduction and methods
Biochemical remission or ‘cure’ of type 2 diabetes (T2DM) is defined as HbA1c <48 mmol/mol or 6.5% . Remission of T2DM without pharmacological or surgical interventions, is possible with significant calorie restriction and weight loss [2,3]. Reducing total energy intake to 624-700 kcal/day for 8 weeks has been associated with remission in 87% of people with recently diagnosed diabetes (<4 years) and in 50% of those with longstanding disease .
In the Look-AHEAD trial, participants had a mean diabetes duration of 5 years and after an intensive 4-year lifestyle program 11.5% achieved partial or complete remission compared to only 2.0% in the usual care group . In the DIRECT trial, participants with a diabetes diagnosis in the past 6 years underwent an intensive intervention, consisting of discontinuation of diabetes and BP medication, and total calorie intake of 825-853 kcal/day via a formula diet for 3-5 months and stepped food reintroduction and structured support. 46% Of participants in the intervention group achieved remission .
It should be noted that these studies recruited selected participants. Evidence from representative population-based samples undergoing less intensive interventions to support the hypothesis that healthy behavior change and weight loss can result in remission of diabetes, is lacking. Moreover, it is unknown whether behavior change and weight loss early in the disease trajectory could lead to long-term remission.
Using data from the ADDITION-Cambridge population-based study of screening for T2DM, this study analyzed the association between behavior change and weight loss in the year after diagnosis and the 4 subsequent years, and the likelihood of remission of diabetes at 5-year follow-up. ADDITION-Cambridge is a pragmatic, parallel group cluster randomized controlled trial that prospectively collects data in 49 general practices in England. 867 Persons aged 40-69 years without diabetes, but in the top 25% of diabetes risk, agreed to attend a stepwise T2DM screening program. At a practice level, participants were randomized to a multifactorial intervention (more frequent consultations, provision of educational materials and encouragement of earlier use of medication to improve risk factor control) or routine care. Weight and HbA1c data at 5 years was available for 730 participants.
- After 5-year follow-up, 55% of participants had started taking hypoglycemic medication.
- Diabetes remission was achieved in 257 (30%) of participants.
- Participants who achieved remission were more likely to be men (59 vs. 38%), smokers (baseline: 15 vs. 20%, at 1 year: 12% vs. 16%) and to have remained in full-time education until the age of 16 years (44 vs. 38%).
- Log binomial regression models revealed that people who lost ≥10% body weight in the first year after diagnosis, were significantly more likely to achieve remission at 5 years, compared to those with stable (RR: 1.77, 95%CI: 1.32-2.38, P<0.01) or increased weight (RR: 0.79, 95%CI: 0.52-1.21 vs no change). Weight loss of 5-10% or less showed similar, non-significant trends.
- No consistent patterns of associations between unit changes in health behaviors and remission diabetes were noted.
In this population-based study, modest weight loss of ≥10% in the first year or first 5 years after diagnosis was associated with remission of T2DM. Thus, these data suggest that remission is achievable without intensive lifestyle interventions or extreme calorie restrictions.