Weight loss in year after diagnosis linked to greater odds of type 2 diabetes remission
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Key takeaways:
- Adults who lose weight in the year after being diagnosed with type 2 diabetes are more likely to achieve diabetes remission.
- Weight regain after remission increases the risk for returning to hyperglycemia.
Adults who lose any amount of weight 1 year after being diagnosed with type 2 diabetes are more likely to achieve diabetes remission than those who gain weight, according to study data published in PLOS Medicine.
“Remission of type 2 diabetes is achievable in real-world settings,” Andrea O. Y. Luk, MBChB, FHKCP, FHKAM, professor in the department of medicine and therapeutics, faculty of medicine at The Chinese University of Hong Kong, and specialist in endocrinology, diabetes and metabolism and honorary consultant for the Hong Kong Hospital Authority, and colleagues wrote. “Greater weight loss within the first year of diabetes diagnosis was associated with an increased likelihood of achieving diabetes remission and a decreased risk of returning to hyperglycemia among those who had achieved diabetes remission. However, both the incidence of diabetes remission and the probability of its long-term sustainability were low with conventional management in real-world settings.”
Researchers conducted an observational cohort study using data from the Hong Kong Hospital Authority electronic medical record system and the Risk Assessment and Management Programme–Diabetes Mellitus (RAMP-DM). Adults diagnosed with type 2 diabetes within 1 year of their baseline visit from 2000 to 2017 were included in the study. Baseline body weight was measured at the first assessment. Follow-up body weight was measured at the visit closest to 1 year after baseline. Type 2 diabetes remission was defined as two or more consecutive HbA1c measurements of less than 6.5% for an interval of at least 6 months without the use of glucose-lowering drugs and with no record of glucose-lowering drug use for at least 3 months before the first HbA1c measurement of less than 6.5%. Return to hyperglycemia was the use of glucose-lowering drugs or an HbA1c measurement of 6.5% after diabetes remission. All-cause and cause-specific mortality was also collected.
Weight loss boosts diabetes remission odds
The study included 37,326 adults (50.5% men; mean age, 56.6 years). Adults achieved a mean weight reduction of 0.2% at 1 year post-diabetes diagnosis. Of the study group, 2.8% lost 10% or more weight at 1 year, 10.4% lost 5% to 9.9% of their body weight, 40.2% achieved a weight loss of 0% to 4.9% and 46.6% gained weight.
During a median follow-up of 7.9 years, 6.1% of participants achieved diabetes remission. Adults who lost 10% or more of their body weight (adjusted HR = 3.28; 95% CI, 2.75-3.92; P < .001), 5% to 9.9% of their body weight (aHR = 2.29; 95% CI, 2.03-2.59; P < .001) and 0% to 4.9% of their body weight (aHR = 1.34; 95% CI, 1.22-1.47; P < .001) were more likely to achieve diabetes remission than those who gained weight.
During a median follow-up of 3.1 years from the date of remission, 67.2% of adults who achieved diabetes remission returned to hyperglycemia. Those who returned to hyperglycemia had an increase in mean body weight of 0.82% from the weight measured at 1 year post-diagnosis, whereas those who remained in remission lost an additional 0.88% of their weight. Adults who lost 10% or more body weight at 1 year (aHR = 0.52; 95% CI, 0.41-0.65; P < .001) or 5% to 9.9% of their body weight (aHR = 0.78; 95% CI, 0.68-0.92; P = .002) had a lower risk of returning to hyperglycemia than those who gained weight.
Diabetes remission lowers mortality risk
There were 2,163 deaths occurring during a median follow-up of 7.9 years. Adults who achieved diabetes remission had a lower all-cause mortality risk than who did not achieve remission (HR = 0.69; 95% CI, 0.52-0.93; P = .014).
“The findings of this study demonstrate the important role of early weight management in achieving and maintaining diabetes remission in real-world settings,” the researchers wrote. “The low incidence of diabetes remission with conventional management and the difficulty in maintaining it underscore the importance of setting realistic expectations and prioritizing the global effort of using both public and personalized measures to prevent the onset of diabetes in high-risk individuals.”
The researchers added that more studies are needed to examine the feasibility, sustainability and cost-effectiveness of weight management interventions at the population level to see if they could be applied in a real-world setting.
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