Rates of diabetes remission and sustainability from weight loss

1. Diabetes remission was achievable for participants through weight loss by surgery or lifestyle changes.

2. At a median follow-up of 3.1 years, two thirds of patients who achieved remission returned to a hyperglycemic state.

Evidence Rating Level: 2 (Good)

A commonly held belief is that there is no cure for type 2 diabetes. Optimistically, recent clinical trials have shown that remission is possible through sustained weight loss in overweight or obese individuals. Early weight control, especially within the first year after diagnosis, is extremely important in those with type 2 diabetes as it can prevent diabetes-related complications while also improving outcomes in the long term. Those included in the study were individuals who were recently diagnosed with type 2 diabetes between the ages of 18-75 years, and who had their first RAMP-DM assessment between January 1, 2000, and December 31, 2017. Individuals with extreme BMI or who had pre-existing cardiovascular disease, cancer, or end-stage renal were excluded to reduce the likelihood of confounding variables altering the results. This selected population was then divided into 4 different groups based on their weight change after 1 year. The incidence of remission of type 2 diabetes was the primary outcome investigated and was compared through the 1-year change in weight circumference with the incidence of diabetes remission and the incidence of returning to a hyperglycemia state. Of individuals who lost the most weight in the year, the majority of them were women and had higher baseline measures such as blood pressure and lipid levels. As well, these individuals were less likely to be current users of alcohol or tobacco. At baseline, the mean BMI was 26.4 (SD: 4.2) kg/m², and the mean HbA1c was 7.7% (SD: 1.8%). After the 1 year, 40.2% of participants had a weight loss of 0% to 4.9%, 2.8% had a weight loss of ≥ 10%, 10.4% had a weight loss between 5% to 9.9%, and 46.6% of people gained weight. After following the patients for a median time of 7.9 years, 6.1% of people achieved remission. Losing more weight had a greater association with diabetes remission. Along a median follow-up time of 3.1 years, 67.2% of those who achieved remission returned to their hyperglycemic state.  The crude incidence rate for this was 184.8 (95% confidence interval {CI}: 175.5, 194.0) per 1000 person-years. Overall, the study shows that people living with type 2 diabetes can achieve and maintain remission following weight loss.

Click to read the study in PLOS

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