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Intensive lifestyle intervention led to partial remission of type 2 diabetes
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According to data from a new study published in JAMA, overweight adults who participated in an intensive lifestyle intervention were more likely to have partial remission of type 2 diabetes. However, the absolute remission rates were modest.
Edward W. Gregg, PhD, of the CDC, and colleagues conducted an ancillary observational analysis of a 4-year randomized, controlled trial to determine whether an intensive lifestyle intervention that included counseling sessions and targets to reduce caloric intake and increase physical activity was associated with partial or complete remission of type 2 diabetes.
According to the researchers, adults with type 2 diabetes and BMI ≥25 were included (n=4,503). The patients “were randomly assigned to intensive lifestyle intervention with weekly group and individual counseling in the first 6 months, followed by three sessions per month for the second 6 months and twice-monthly contact and regular refresher group series and campaigns in years 2 to 4 (n=2,241); or a diabetes support and education (DSE) control group that included three group sessions per year about diet, physical activity and social support.”
The primary endpoint was partial or complete remission of diabetes, defined as transitioning from diabetes to prediabetes or nondiabetic glycemia levels (fasting plasma glucose <126 mg/dL and HbA1c <6.5% without antihyperglycemic medication).
Significantly more weight was lost in the intervention group vs. the DSE group at 1 year, with a –7.9% net difference (95% CI, -8.3% to -7.6%); and at year 4, the net difference was –3.9% (95% CI, –4.4% to –3.5%).
Additionally, at years 1 and 4, the intervention group had a superior increase in fitness compared with the DSE group (net difference: 15.4%; 95% CI, 13.7%-17% and net difference: 6.4%; 95 CI, 4.7%-8.1%).
Any remission, whether partial or complete, was more likely among patients in the intervention group at both 1 and 4 years (prevalence: 11.5%; 95% CI, 10.1%-12.8% and 7.3%; 95% CI, 6.2%-8.4%), compared with DSE (prevalence: 2.% at both time points; P<.001).
Among the intervention group, continuous, sustained remission occurred for at least 2 years in 9.2% of patients (95% CI, 7.9%-10.4%); for at least 3 years in 6.4% of patients (95% CI, 5.3%-7.4%); and for at least 4 years in 3.5% of patients (95% CI, 2.7%-4.3%), compared with <2% of patients in the DSE arm (1.7% for at least 2 years [95% CI, 1.2%-2.3%]; 1.3% for at least 3 years [95% CI, 0.8%-1.7%]; and 0.5% for at least 4 years [95% CI, 0.2%-0.8%]).
“The increasing worldwide prevalence of type 2 diabetes, along with its wide-ranging complications, has led to hopes that the disease can be reversed or prevented,” the researchers wrote. “These analyses of more than 4,500 overweight adults with type 2 diabetes confirm that complete remission associated with an intensive lifestyle intervention, when defined by glucose normalization without need for drugs, is rare. However, partial remission, defined as transition to prediabetic or normal glucose levels without drug treatment for a specific period, is an obtainable goal for some patients with type 2 diabetes.”
In an accompanying editorial, David E. Arterburn, MD, MPH, of the Group Health Research Institute in Seattle, and Patrick J. O’Connor, MD, MA, MPH, of the HealthPartners Institute for Education and Research in Minneapolis, said that “evidence-based and cost-effective diabetes prevention strategies should be more broadly applied using the full range of available technologies and incentives.”
“But that is not enough,” they wrote. “Research, education, and policy efforts need to be focused further upstream, toward primary prevention: reducing incident obesity in children, adolescents and adults, especially among those with a family history of obesity or diabetes. Prevention of diabetes and obesity should be a rallying cry for all clinicians who care about the health of the nation.”
Disclosure: See the study and editorial for a full list of relevant financial disclosures.
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