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This article originally posted and appeared in  Public HealthIssue 658

Intensive Program Reverses Diabetes

Researchers find that intense lifestyle-based weight-loss interventions were associated with a remission of diabetes....

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According to Edward Gregg, PhD, of the Centers for Disease Control and Prevention, and colleagues, compared with an education and support intervention for diabetes patients, those engaged in an intense weight-loss and lifestyle intervention were more likely to experience any remission at year 1 (11.5% versus 7.3%, P<0.001), and were more likely to see that remission continuously sustained over 3 years of measurements (9.2%, 6.4%, and 3.5% versus 1.7%, 1.3%, and 0.5%, respectively.

Participants in the intervention group also lost significantly more weight at two follow-up periods (a difference of 7.9% at year one and 3.9% at year four, P<0.001 for both), and significantly fewer participants in the weight-loss intervention who experienced remission returned to clinical diabetes status at each point of follow-up.

The researchers also noted that the weight-loss intervention was particularly effective in "those whose diabetes is of short duration, who have lower hemoglobin A1c levels, and who do not yet require insulin therapy."

Patients diagnosed as having type 2 diabetes frequently ask if their condition is reversible, and "some physicians may provide hopeful advice that lifestyle change can normalize glucose levels," they wrote in the introduction to their findings. "However, the rate of remission of type 2 diabetes that may be achieved using nonsurgical approaches has not been reported."

To help clarify the issue, the researchers investigated the outcomes of a long-term (4 years) intensive weight-loss intervention on frequency of remission from diabetes to prediabetes or normoglycemia in 2,241 participants and compared them with a sample of 2,262 diabetes patients participating in a diabetes and support education intervention.

The intensive weight-loss intervention included weekly group and individual counseling for the first 6 months focused on reducing caloric intake, decreasing consumption of total and saturated fats, and increasing physical activities; this was followed by three sessions per month for the second 6 months and twice-monthly sessions over years 2 to 4. Participants also were offered liquid meal replacements to help with dietary goals.

In the support education intervention participants were given three group sessions annually that offered information on diet, physical activity, and social support.

Participants in each group were evaluated at baseline and once at each year of the 4 years of follow-up for health status, including body mass index and glycemic status. Participant fitness also was assessed at baseline through a maximal graded exercise test and at years one and four through a submaximal exercise test.

The participants were 45 to 75 years old with a mean age of 59 years, had a median time since diabetes diagnosis of 5 years, and were "notably obese at baseline."

In addition to losing more weight, the weight-loss intervention group had greater increases in fitness in years one and four (20.6% versus 4.9% and 5.3% versus 1.5%, respectively, P<0.001 for both) than those in the education group.

Complete remission -- defined as glucose normalization without medication -- was more common among the lifestyle weight-loss participants than the education group (prevalence ratio 6.6, 95% CI 3.3 to 13.3, P<0.001). Absolute prevalence of complete remission was low overall, the authors noted. Participants were significantly more likely to experience either partial or complete remission in the lifestyle intervention than in the education intervention at years 1 and 4 (P<0.001 for both).

Return to clinical diabetes status occurred in roughly one-third of the lifestyle intervention group each year (33.1% at year two, 33.8% at year three, and 31.6% at year four) versus around half among participants in the education group (52.4% at year two, 45.9% at year three, and 43.8% at year four). In addition, continuous, sustained remission was significantly more common among weight-loss intervention participants than in the education group at years two to four (P<0.001 for all).

Practice Pearls:
  • Participants in the intervention group also lost significantly more weight at two follow-up periods.
  • Intense lifestyle-based weight-loss interventions were associated with a partial remission of diabetes, researchers found.

Gregg EW, et al "Association of an intensive lifestyle intervention with remission of type 2 diabetes" JAMA 2012; 308(23): 2489-2496. 

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This article originally posted 04 January, 2013 and appeared in  Public HealthIssue 658

Past five issues: Diabetes Clinical Mastery Series Issue 256 | Issue 796 | Diabetes Clinical Mastery Series Issue 255 | Issue 795 | SGLT-2 Inhibitors Special Edition August 2015 |

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