Remission of type 2 diabetes: Mission Not Impossible.
In the Management of Hyperglycemia in Type 2 Diabetes, 2018.A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD), on page 12 and 18, they reference the results of the DiRECT study below. They recommend that all overweight and obese PWD be advised of the health benefits of weight loss and encouraged to engage in an intensive lifestyle program to achieve weight loss reduction.
The DiRECT study, published in the Lancet in February 2018, aimed to assess whether intensive weight management within routine primary care would achieve remission of type 2 diabetes.
Goals of the study were weight loss of 15 kg or more and remission of diabetes, defined as A1c less than 6·5%, after at least 2 months off all antidiabetic medications, from baseline to 12 months.
To evaluate if this was possible, the research team initiated an open-label, cluster-randomised trial (DiRECT) at 49 primary care practices in Scotland and the Tyneside region of England. They recruited individuals aged 20-65 years who had been diagnosed with type 2 diabetes within the past 6 years, had a body-mass index of 27-45 kg/m2, and were not receiving insulin.
All diabetes and hypertension medications were stopped and very low calorie diet was started.
- Total diet replacement (825-853 kcal/day formula diet for 3-5 months)
- stepped food reintroduction (2-8 weeks),
- and structured support for long-term weight loss maintenance.
Outcome:
For 12 months, two groups consisting each of 149 participants were followed. The intervention group received weight management support and the control group received no weight loss intervention.
At end of study (12 months), diabetes remission was achieved in 68 (46%) participants in the intervention group and six (4%) participants in the control group
Diabetes remission rates associated with weight status at 12 months:
- Six (7%) of 89 participants with 0-5 kg weight loss
- 19 (34%) of 56 participants with 5-10 kg loss,
- 16 (57%) of 28 participants with 10-15 kg loss,
- 31 (86%) of 36 participants who lost 15 kg or more.
Other interesting observations:
- Mean body weight fell by 10·0 kg in the intervention group and 1·0 kg in the control group.
- 36 (24%) participants had a weight loss of 15 kg or more in the intervention group
- In the control group, no participants reached the target of 15 kg weight loss
- Remission varied with weight loss in the whole study population. 76 participants gained weight and had no remission
- Quality of life improved by 7·2 points in the intervention group, and decreased by 2·9 points in the control group.
Nine serious adverse events were reported by seven (4%) of 157 participants in the intervention group and two were reported by two (1%) participants in the control group. Two serious adverse events (biliary colic and abdominal pain), occurring in the same participant, were deemed potentially related to the intervention. No serious adverse events led to withdrawal from the study.
What does this mean?
The results show that, at 12 months, almost half of participants in intervention group achieved, with a mean weight loss of 10%, experienced remission to a non-diabetes state without diabetes medications.
The authors conclude that remission of type 2 diabetes through a structured weight loss intervention is a practical target for primary care
Want to read more?
Lancet. 2018 Feb 10;391(10120):541-551. doi: 10.1016/S0140-6736(17)33102-1. Epub 2017 Dec 5.
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