ATLANTA – An intensive weight loss program involving dieting, counseling and physical activity offers the promise of diabetes remission, especially in patients who are recently-diagnosed, not on insulin and have lower hemoglobin A levels.
The study, partly funded by the VA, found that, compared with only education and support, the more intensive intervention created a higher rate of remission in the first year – 11.5% vs. 7.3%, P<0.001. The remission also was more likely to be sustained over a three-year period: 9.2%, 6.4%, and 3.5% compared with 1.7%, 1.3%, and 0.5% in the education and support group, according to the study led by researchers from Centers for Disease Control and Prevention in Atlanta.1
Measured over time, participants in the intensive intervention group also lost considerably more weight at two follow-up periods – a difference of 7.9% at Year One and 3.9% at Year Four. Furthermore, according to the study authors, notably fewer weight-loss intervention participants who experienced remission returned to clinical diabetes status at each point of follow-up.
In the article appearing online in the Journal of the American Medical Association, The researchers pointed out that the weight-loss intervention was most effective in “those whose diabetes is of short duration, who have lower hemoglobin A levels, and who do not yet require insulin therapy.”
The authors note in the article’s introduction that their research sought to determine how reversible diabetes can be without surgery.
For the study, researchers looked at the outcomes of 2,241 participants in a four-year intensive weight-loss intervention on frequency of remission from diabetes to prediabetes or normoglycemia, then compared those results with a sample of 2,262 diabetes patients participating in a diabetes and support education intervention. Study subjects were a mean age of 59 years old and generally were obese at baseline.
Included in the intensive weight-loss intervention were weekly group and individual counseling on reducing calorie intake and fat consumption while increasing physical activity for the first six months. Counseling was reduced to three sessions per month for the second half-year and dropped to twice-monthly session in the remaining three years. Study participants also had the option of using liquid meal replacements to help reach their dietary goals.
In the support education intervention, meanwhile, three group sessions were offered annually, focusing on diet, physical activity and social support.
While glucose normalization without medication was low overall, it 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.
About one-third of the lifestyle intervention group returned to clinical diabetes status each year – 33.1% at Year Two, 33.8% at Year Three, and 31.6% at Year Four – compared with about half of the education group participants — 52.4% at Year Two, 45.9% at Year Three, and 43.8% at Year Four.
Neither intervention meant “”lower rates of nonfatal myocardial infarction, nonfatal stroke, hospitalization for angina, or death compared with conventional diabetes treatment,” according to an accompanying editorial from David Arterburn, MD, of the Group Health Research Institute in Seattle, and Patrick O’Connor, MD, of the Institute for Education and Research in Minneapolis. They suggested that could be because the participants had improved risk factor control and might have been healthier than anticipated at the study’s inception.
1. Gregg EW, et al. “Association of an intensive lifestyle intervention with remission of type 2 diabetes” JAMA 2012; 308(23): 2489-2496.
2. Arterburn DE, O’Connor PJ “A look ahead at the future of diabetes prevention and treatment” JAMA 2012; 308(23): 2517-2518.