New study: Weight loss results in diabetes remission

A new study reveals that even a 10-pound weight loss maintained for at least a year can result in the remission of type 2 diabetes.

A chronic condition requiring lifelong testing and medication, type 2 diabetes is both a costly and difficult disease that many primary care offices struggle to manage effectively. The study, however, published in The Lancet, asserts that intensive weight loss programs are effective in reversing a type 2 diabetes diagnosis and are practical for primary care practices to implement.

Researchers conducted the trial across 49 primary care practices in the United Kingdom, enrolling more than 300 individuals 20 to 65 years of age who had been diagnosed with diabetes within the last six years. All of the individuals enrolled in the study had a body-mass index of between 27 and 45 kg/². Participants were weaned off all antidiabetic and antihypertensive medications and placed on an 825 kcal to 853 kcal per day formula diet for three months to five months. Regular foods were reintroduced over two weeks to eight weeks, and additional support to maintain long-term weight loss was offered.

For the purposes of the study, participants who reached and A1C level under 6.5% were classified as in remission from type 2 diabetes.

In all, 24% of participants in the intervention group maintained a 33 or more pound weight loss after 12 months, compared to none in the control group. Nearly half-46%- of the intervention group was in diabetes remission, while only 4% in the control group achieved remission during the study period.

Remission rates varied according to the amount of weight lost and maintained, with no remission in the 76 participants who gained weight, six of the 89 patients who lost 0 to 11 pounds achieved remission, 19 of the 56 patients with an 11- to 22-pound weight loss achieved remission and 31 of the 36 patients who maintained a loss of 33 pounds or more were in remission. Additionally, participants in the intervention group reported that their quality of life improved 7.2 points, while the control group reported a decrease of 2.9 points, according to the report.

No one dropped out of the study, according to the report, but some did face adverse effects from the intervention, including one individual who suffered both biliary colic and abdominal pain that researchers said may have been connected to the intervention.

Next: Skepticism about the study

Study skepticism

William T. Cefalu, MD, chief scientific, medical and mission officer for the American Diabetes Association said the study confirms the effect weight loss has on improving glycemic control, adding that the study’s definition of remission at an A1C of less than 6.5% is more permissive that the ADA’s 5.6%. Ceflau cautioned that the study also used intensive nutritional interventions that are difficult to maintain.

“While the results found in this study are remarkable and admirable for achieving significant weight loss in the intervention group, they represent the ideal of intensive primary care treatment that cannot always be replicated in today’s clinical health care settings,” Cefalu told Medical Economics. “The most successful diet pattern is one that an individual can follow long-term-that acknowledges cultural differences and expectations, financial and economic conditions, geographical availability of foods and each individual’s nutritional needs.”

Roy Taylor, professor of medicine and metabolism at the Magnetic Resonance Centre and the Campus for Ageing and Vitality at Newcastle upon Tyne and co-author of the study said his research demonstrates that living with a type 2 diabetes diagnosis is not a permanent state and can be changed as a matter of choice and effort.

“Type 2 diabetes is a simple reversible condition in the first few years.  Substantial weight loss will re-establish normal glucose control, and this will be maintained long term providing weight re-gain is avoided,” Taylor said, noting that there have been documented cases of individuals achieving remission for up to a decade with diet changes.

Taylor said the cost of diabetes to an individual’s health and the healthcare system makes it worthwhile for primary care physicians to have an honest conversation with patients with type 2 diabetes.

“The diagnosis of type 2 diabetes should lead to explanation that the person has a choice,” Taylor said. “Lose 15% of body weight and get back to health, or face a future of being labeled diabetic, with tablets, side effects of tablets, ultimately insulin injections, loss of sight, amputation and early death.”