Intensive Lifestyle Intervention Associated With Partial Remission of Type 2 Diabetes
|Intensive lifestyle intervention may be associated with partial diabetes remission in certain patients with type 2 diabetes, particularly those with diabetes that is of short duration, lower HbA1c levels, and/or those that do not yet require insulin therapy, according to a new study published on Dec. 18 in the Journal of the American Medical Association.
The study, an exploratory analysis of the Look AHEAD Trial, compared intensive lifestyle intervention with conventional diabetes support and education control condition (DSE) among 4,503 overweight US adults with type 2 diabetes over four years. Results showed that intensive lifestyle intervention participants were significantly more likely to experience any remission (partial or complete), with prevalences of 11.5 percent (95 percent CI, 10.1 percent-12.8 percent) during the first year and 7.3 percent (95 percent CI, 6.2 percent-8.4 percent) at year four, compared with 2.0 percent for the DSE intervention group at both time points. According to the authors, the study results suggest an intensive lifestyle intervention has a greater likelihood of partial remission of type 2 diabetes compared with DSE. However, the absolute remission rates were modest.
In addition, intensive lifestyle intervention participants lost significantly more weight than DSE participants in the first year (net difference, -7.9 percent; 95 percent CI, -8.3 percent to -7.6 percent) and at the fourth year. They also had greater fitness increases both at year one (net difference, 15.4 percent; 95 percent CI, 13.7 percent–17.0 percent) and year four (6.4 percent; 95 percent CI, 4.7 percent–8.1 percent) (P<.001 for each).
In a related editorial comment, authors note that while the study's results confirm that a lifestyle intervention resulting in weight loss may benefit some patients—especially those with early diabetes ... compared with routine diabetes care, the lifestyle intervention appears to do little to reduce major cardiovascular events or death. "They point out that bariatric surgery already appears to reduce cardiovascular events and mortality rates among severely obese patients and may be more effective than medical or lifestyle interventions for weight loss and diabetes remission." The authors urge more research, education, and policy efforts that are "focused further upstream, toward primary prevention: reducing incident obesity in children, adolescents, and adults, especially among those with a family history of obesity or diabetes."
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