Written by Marcia J. Egles, MD. Study validates the association between weight loss and type 2 diabetes mellitus remission.
A British study of newly diagnosed adult diabetics followed for five years showed that sustained remission of type 2 diabetes may be achievable with even modest levels of weight loss. Thirty percent of the study’s participants who attained a 10 percent weight loss were found to be in diabetic remission at five years of follow-up.
Globally, type 2 diabetes mellitus (also known as adult-onset diabetes or non-insulin dependent diabetes) has been described as an escalating epidemic affecting over 400 million people at an estimated yearly cost of $673 billion dollars (U.S.). Over 5 million deaths were attributed to diabetes in 2015 1. According to one Scottish database, the typical percentage of those achieving remission after a type 2 diabetes diagnosis is on the order of 0.1%. 2.
Remission in type 2 diabetes is generally defined as a level of glycemia (that is, serum glucose, or sugar in the blood) of less than the diagnostic threshold in the absence of pharmacological interventions. The diagnostic threshold for diabetes remission used in the study was a Hemoglobin A1c of less than 48 mmol/mol or less than 6.5%. 3, which is the threshold used in the United Kingdom as well as the United States.
Collectively, other studies in the past have supported the observation that weight loss can result in remission of diabetes 2,4,5. However, many of these studies have used drastic caloric restrictions on a short-term basis with unrealistic applications to community diabetic populations. For example, an intensive caloric restriction of 624-700 kcal/day for 8 weeks was associated with remission of 87% of people with recently diagnosed diabetes and of 50% of those with longstanding disease of more than eight years 2.
The British study, known as the ADDITION-Cambridge trial, was a study of 867 adults aged 40-69 whose diabetes was detected by community screening between 2002 and 2006 3. The geographical area included eastern England. The participants underwent assessment of body weight, physical activity, and diet at baseline and at one year after diagnosis. After 5 years of follow-up, remission was determined by Hemoglobin A1c levels. Sixteen percent of the participants were lost to follow-up analysis.
Percentage weight change over the first year, and percentage weight changes between 1 and 5 years, were major variables assessed by the study. Diabetes remission was achieved in 257 participants (30%) at five year follow-up. Compared with persons who maintained the same weight, those who achieved a 10 percent weight loss in the first year had a significantly higher likelihood of remission (risk ratio 1.77 with 95% C.I. 1.32 to 2.38, p less than 0.01). A weight loss of 10 percent or more early in the disease was associated with a doubling of the likelihood of disease remission at 5 years.
The study’s findings support previous research that demonstrate associations between weight loss and remission of type 2 diabetes mellitus 2-5. The researchers emphasized that many people in their study obtained remission of type 2 diabetes without intensive lifestyle interventions or extreme caloric restriction 3.
Source: Dambha‐Miller, Hajira, Alexander J. Day, Jean Strelitz, Greg Irving, and Simon J. Griffin. “Behaviour change, weight loss and remission of Type 2 diabetes: a community‐based prospective cohort study.” Diabetic Medicine (2019).
© 2019 The Authors.
Posted January 13, 2020.
Marcia Egles, MD, graduated from Vanderbilt University School of Medicine in 1986. She completed her residency in Internal Medicine at St. Louis University Hospital. Dr. Egles is certified in Internal Medicine and is a member of the American College of Physicians. She resides in Avon, IN with her husband and two sons.
References:
- Ogurtsova K, da Rocha Fernandes J, Huang Y, et al. IDF Diabetes Atlas: Global estimates for the prevalence of diabetes for 2015 and 2040. Diabetes research and clinical practice. 2017;128:40-50.
- McCombie L, Leslie W, Taylor R, Kennon B, Sattar N, Lean ME. Beating type 2 diabetes into remission. Bmj. 2017;358:j4030.
- Dambha‐Miller H, Day AJ, Strelitz J, Irving G, Griffin SJ. Behaviour change, weight loss and remission of Type 2 diabetes: a community‐based prospective cohort study. Diabetic Medicine. 2019.
- Gregg EW, Chen H, Wagenknecht LE, et al. Association of an intensive lifestyle intervention with remission of type 2 diabetes. Jama. 2012;308(23):2489-2496.
- Lean ME, Leslie WS, Barnes AC, et al. Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial. The Lancet. 2018;391(10120):541-551.
