Achieving type 2 diabetes remission lowers risk for CKD, CVD
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Key takeaways:
- Adults with type 2 diabetes can reduce their risk for CKD and CVD if they lower their HbA1c to less than 6.5%
- A greater risk reduction was seen for adults who maintained diabetes remission at multiple visits.
Adults who achieve type 2 diabetes remission are less likely to develop chronic kidney disease and cardiovascular disease, according to study findings published in Diabetologia.
In a post hoc analysis of the Look AHEAD trial, adults who had diabetes remission during any follow-up visit reduced their risk for CKD and CVD, regardless of whether they were in the trial’s intensive lifestyle intervention arm or the diabetes support and education arm.
“This is the first study we are aware of to look beyond the efforts and attainment of remission to consider longer-term implications,” Edward W. Gregg, PhD, professor of population health at the Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences and Imperial College London, told Healio. “These findings are encouraging in terms of the magnitude of reduction in risk.”
Gregg and colleagues collected data from 4,488 adults aged 45 to 76 years with type 2 diabetes and overweight or obesity who participated in Look AHEAD, a randomized controlled trial in which adults were randomly assigned to intensive lifestyle intervention or diabetes support and education. Baseline clinic visits occurred from August 2001 to April 2004. Follow-up visits took place annually for 4 years and then every other year up to 12 years. Adults were considered to have diabetes remission if they had an HbA1c of less than 6.5% with no use of glucose-lowering medications at any follow-up. Incidence of high-risk or very high-risk CKD was defined as an estimated glomerular filtration rate of less than 45 mL/min/1.73 m2, an eGFR of less than 60 mL/min/1.73 m2 plus a urine albumin-to-creatinine ratio of at least 30 mg/g or any eGFR level with an albumin-to-creatinine ratio of more than 300 mg/g. CVD was defined as any occurrence of CVD death, nonfatal acute myocardial infarction, nonfatal stroke or hospital admission for angina.
Diabetes remission was achieved by 12.7% of adults at least once during the study. The rate of diabetes remission remained about 2% for the diabetes support and education group throughout the follow-up. Adults receiving intensive lifestyle intervention had a diabetes remission prevalence of 11.2% at 1 year, which declined by about 0.7 percentage points annually until it reached 3.7% at 12 years.
In multivariable analysis, adults who had diabetes remission during any point in the study had a lower risk for CKD (adjusted HR = 0.67; 95% CI, 0.52-0.87) and CVD (aHR = 0.6; 95% CI, 0.47-0.79) than adults who did not achieve diabetes remission. The risk for CKD and CVD was lowest for those who had diabetes remission during at least four follow-up visits. Gregg said he was surprised to see such a large risk reduction with diabetes remission.
“When people are able to achieve remission from their type 2 diabetes, it is associated with more than just the diminishing of diabetes, but also a reduction in risk of later disease outcomes commonly associated with diabetes,” Gregg said.
In an analysis stratified by randomization group, adults receiving intensive lifestyle intervention who achieved diabetes remission had a lower risk for CKD (aHR = 0.66; 95% CI, 0.48-0.91) than those who did not have diabetes remission, but no difference was observed for CVD risk. Among the diabetes support and education group, adults who achieved diabetes remission at any point had a lower CVD risk than those who did not have diabetes remission (aHR = 0.32; 95% CI, 0.18-0.59), but no association was found with CKD risk.
Gregg said more long-term studies assessing the impact of diabetes remission are needed using a wider variety of intensive lifestyle interventions.
For more information:
Edward W. Gregg, PhD, can be reached at e.gregg@imperial.ac.uk.
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