This article is more than 5 years old. Information may no longer be current.
Intensive therapy may result in type 2 diabetes remission
In adults with type 2 diabetes, a short course of intensive lifestyle and medical therapy can lead to normoglycemia and sustained weight loss, and may lead to prolonged, drug-free diabetes remission, according to findings from a randomized, open-label pilot trial.
“By using a combination of oral medications, insulin and lifestyle therapies to treat patients intensively for 2 to 4 months, we found that up to 40% of participants were able to stay in remission 3 months after stopping diabetes medications,” Natalia McInnes, MD, MSc, FRCPC, of McMaster University and Hamilton Health Sciences in Ontario, Canada, said in a press release. “The findings support the notion that type 2 diabetes can be reversed, at least in the short term — not only with bariatric surgery, but with medical approaches.”
McInnes and colleagues analyzed data from 83 adults with a BMI of at least 23 kg/m² who had type 2 diabetes for at least 3 years and an HbA1c of at least 8.5% with no oral diabetes drugs or an HbA1c of 7.5% on one diabetes drug or half maximal doses of two drugs for at least 8 weeks (mean age, 57 years; 52% women; mean diabetes duration, 14.6 months; mean HbA1c, 6.6%). Between February 2011 and January 2014, participants were randomly assigned one of three groups: an 8-week intensive metabolic intervention (n = 28), a 16-week intensive metabolic intervention (n = 27) or standard diabetes care (n = 28). During the intensive periods, researchers used targeted lifestyle approaches (dietary and physical activity interventions), as well as combinations of metformin, acarbose and insulin glargine; diabetes drugs were then discontinued in the intervention groups and participants were followed for hyperglycemic relapse. The standard care group received standard lifestyle advice and were provided with a pedometer as an incentive to be more active while receiving standard glycemic management with their diabetes care provider during the trial. The primary outcome was normoglycemia with treatment.
At 8 weeks, 50% of participants in the 8-week intensive group had normoglycemia vs. 3.6% assigned standard care (RR = 14; 95% CI, 1.97-99.38); at 18 weeks, 70.4% of participants in the 16-week intensive group had normoglycemia vs. 3.6% assigned standard care.
At 12 weeks’ follow-up, 21.4% of participants in the 8-week group met the HbA1c criteria for complete or partial diabetes remission vs. 10.7% assigned standard care (RR = 2; 95% CI, 0.55-7.22), whereas 40.7% of participants in the 16-week group met partial or complete diabetes remission criteria vs. 14.3% assigned standard care (RR = 2.85; 95% CI, 1.03-7.87).
During 28 weeks of follow-up, 35.7% of participants in the 8-week intensive group and 63% of participants in the 16-week intensive group achieved at least 5% weight loss from baseline vs. 10.7% assigned standard care, according to the researchers. At 52 weeks, 28.8% of participants in the 8-week group and 40.7% of participants in the 16-week intensive group were on no diabetes drugs vs. 35.7% assigned standard care. No participants experienced serious adverse events or episodes of severe hypoglycemia.
“For years, we used to think that type 2 diabetes is a progressive irreversible disease and focused on maintaining good sugar levels with the help of medications,” McInnes told Endocrine Today. “This study, along with other published studies, suggest that it might be possible to reverse type 2 diabetes, at least in the short term, with intensive medical approaches combining drugs and lifestyle therapy. This is very encouraging for patients.”
The researchers noted that other drug combinations in addition to metformin, acarbose and basal insulin glargine could lead to higher remission rates and should be systematically studied.
“We need to find out who responds to intensive medical treatment, how long the intensive treatment should be, what combinations of drugs we should use to achieve higher rates of remission and the best ways to deliver lifestyle therapy so it can induce sustained weight loss,” McInnes said. – by Regina Schaffer
Disclosure: The Canadian Diabetes Association and the Population Health Research Institute funded this study. McInnes reports receiving grant funding from AstraZeneca, Merck and Sanofi for other research. Please see the full study for the other authors’ relevant financial disclosures.