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Type 2 Diabetes Remission With Intensive Treatment

Theory proposed that type 2 diabetes can be reversed in the short term with medical approaches over bariatric surgeries.

Type 2 diabetes can be acquired over time when a person makes poor lifestyle choices with their diet and lives a sedentary lifestyle. Eventually, it progresses to a chronic state with additional complications, but it can be reversed with lifestyle approaches and a series of oral and injectable medications. According to the Society’s Endocrine Facts and Figures, one in 10 American adults has type 2 diabetes and either cannot produce enough insulin or their pancreas is not making insulin efficiently. Thus, resulting in an increase in blood sugar and keeping the cells from receiving energy. Ongoing studies have stressed treating type 2 diabetes by reversing the disease rather than controlling its progression by achieving normoglycemia.

Recent studies show that intensive medical treatment for two to four months, using oral medications, insulin and lifestyle therapies may help reverse type 2 diabetes. In an open-labeled, parallel, randomized pilot trial, a short-term intensive metabolic approach was conducted to target the fasting and postprandial normoglycemia and weight loss using a combination of pharmacological and lifestyle approaches to induce sustained diabetes remission. The objective of the study was to assess the feasibility, safety, and potential to induce remission of a short-term intensive metabolic strategy. All analyses were performed using the intention-to-treat principle. A chi-square test and two sample t-test was used to compare dichotomous and continuous outcomes, respectively.

The interventional, phase-4 study enrolled 83 participants with type 2 diabetes for up to three years of duration that were followed for 52 weeks. Participants were randomly divided into three study groups: a control group and two study groups. Study group one underwent a shorter intervention period for eight weeks; study group two underwent an intensive treatment for 16 weeks; and the control group received the standard glycemic care with blood sugar management and lifestyle advice. Study groups one and two received an intensive metabolic intervention with a personalized exercise plan and a suggested meal plan, which reduced their daily calorie intake by 500-750 calories a day. The intervention groups used metformin, acarbose and basal insulin glargine to slow or prevent the development of type 2 diabetes. Subjects were regularly followed up to receive medications, to tightly manage their blood glucose levels, and to track their progress. Following completion of intervention, lifestyle changes were encouraged, and all three groups received the usual diabetes care for diabetes relapse.

The study participants measured and assessed their blood sugar levels from the past two to three months using a HbA1C blood test at week 8, 20, 28 and 52. They also undertook oral glucose tolerance tests (OGTT). After three months of completing the 16 weeks of intervention, 11 out of 27 subjects in the intervention group met HbA1C criteria for complete or partial diabetes remission versus 4 out of 28 individuals in the control group. After three months of completing the 8 weeks of intervention, 6 out of 28 individuals met the same criteria for complete or partial diabetes remission. Thus, at the end of the 8-week intensive metabolic intervention, 50% versus 3.6% of the controlled achieved normoglycemia (RR 14.0, 95% CI, 1.97-99.38) and at 16 weeks, 70.4% versus 3.6% in controlled group (RR 19.7, 2.83-137.13). After 12 weeks of intervention, 21.4% in the 8-week group versus 10.7% in controlled group (RR 2.0, 0.55-7.22) and 40.7% in the 16-week group compared to 14.3% of controlled (RR 2.85, 1.03-7.87) met HbA1C criteria for partial or complete diabetes remission.

The study found that a combination of oral drugs, insulin, and lifestyle changes for up to two to four months helped 40% of subjects with remission three months after their diabetes medications were ceased. Thus supporting the theory that type 2 diabetes can be reversed in the short term with medical approaches as opposed to bariatric surgeries. No serious adverse events or hypoglycemic episodes were observed.

In conclusion, a short course of intensive lifestyle modification and drug therapy achieved on-treatment normoglycemia and promoted sustained weight loss. Moreover, maintaining these changes would help in achieving prolonged, drug-free diabetes remission and support ongoing studies of novel medical regimens targeting remission. Future trials should focus on active follow up during off-drugs period for a longer period of time to analyze the remission rates while on proposed therapeutic approach. Moreover, further studies can help identify the effective combination of medications to induce diabetes remission and reduce the complications related to type 2 diabetes to improve the overall quality of life.

Practice Pearls:

  • Intensive medical treatment can reverse type 2 diabetes.
  • The study suggests that type 2 diabetes can be reversed with intensive medical treatment using oral medications, insulin, and lifestyle therapies.
  • Intensive lifestyle modifications and medical treatment may also help in achieving prolonged and drug-free diabetes remission.

References:

  1. McInnes N, smith A, Otto R, Vandermey J, Punthakee Z, Sherifali D, et al. Piloting a Remission Strategy in Type 2 Diabetes: Results of a Randomized Controlled Trial. The Journal of Clinical Endocrinology & Metabolism. 2017, 24 January.
  2. The Endocrine Society. “Intensive medical treatment can reverse type 2 diabetes: Intervention induced several months of remission in up to 40 percent of clinical trial participants.” ScienceDaily. ScienceDaily, 15 March 2017. <www.sciencedaily.com/releases/2017/03/170315140657.htm>.

Tenzing Dolkar, BSc., PharmD Candidate 2017, Lake Erie College of Osteopathic Medicine, School of Pharmacy