Diabetes Remission Is Possible With Intensive Weight Loss
Remission of type 2 diabetes may be feasible among primary care patients, according to a recent study that found a diet and weight loss intervention eliminated the need for antidiabetic medication among participants who lost 15 kg or more of weight.
For their open-label, randomized trial, the researchers enrolled 309 patients with type 2 diabetes at 49 primary care practices in Scotland and the Tyneside region in England. A total of 149 participants were assigned to a weight management program and 149 participants were assigned to standard care. The intervention involved total diet replacement for 3 to 5 months, stepped food reintroduction for 2 to 8 weeks, withdrawal of antidiabetic and antihypertensive drugs, and structured support for long-term weight loss maintenance.
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The primary outcomes included weight loss of 15 kg or more and remission of diabetes after at least 2 months off all antidiabetic medications, which were assessed from baseline to month 12.
Overall, the mean bodyweight decreased by 10 kg in the intervention group and by 1 kg in the control group. At 12 months, weight loss of 15 kg or more was observed in 36 participants (24%) in the intervention group compared with no participants in the control group, and 68 participants (46%) in the intervention group achieved diabetes remission compared with only 6 participants (4%) in the control group.
The researchers found that remission varied with weight loss. The 76 participants who gained weight did not achieve remission, whereas 6 (7%) of 89 participants who maintained 0 to 5 kg weight loss, 19 (34%) of 56 participants who lost 5 to 10 kg, 16 (57%) of 28 participants who lost 10 to 15 kg, and 31 (86%) of 36 participants who lost 15 kg or more achieved remission.
In addition, quality of life improved by 7.2 points among the intervention group and decreased by 2.9 points among those in the control group.
While no serious adverse events led to withdrawal from the study, 9 were reported by 7 participants in the intervention group and 2 were reported by 2 participants in the control group. One participant experienced both biliary colic and abdominal pain, which was deemed potentially related to the intervention.
“Our findings show that, at 12 months, almost half of participants achieved remission to a non-diabetic state and off antidiabetic drugs,” the researchers concluded. “Remission of type 2 diabetes is a practical target for primary care.”
—Melissa Weiss
Reference:
Lean MEJ, Leslie WS, Barnes AC, et al. Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial [published online December 5, 2017]. Lancet. http://dx.doi.org/10.1016/S0140-6736(17)33102-1.