Posted on Jan 03, 2013, 6 a.m.
Intensive lifestyle-based weight-loss interventions associate with a partial remission of diabetes.
Rates of type-2 diabetes are on the rise, in large part due to the obesity epidemic and rising numbers of the aging population. Edward Gregg, from the US Centers for Disease Control & Prevention (CDC; Georgia, USA), and colleagues investigated the outcomes of a four-year long intensive weight-loss intervention program on the frequency of remission from diabetes to prediabetes or normoglycemia in 2,241 subjects ages 45 to 75 years old with a median time since diabetes diagnosis of 5 years, and were "notably obese at baseline,” comparing them with a sample of 2,262 diabetes patients participating in a diabetes and support education intervention. The intensive weight-loss intervention included weekly group and individual counseling for the first 6 months focused on reducing caloric intake, decreasing consumption of total and saturated fats, and increasing physical activities; this was followed by three sessions per month for the second 6 months and twice-monthly sessions over years 2 to 4. Participants also were offered liquid meal replacements to help with dietary goals. In the support education intervention participants were given three group sessions annually that offered information on diet, physical activity, and social support. Participants in each group were evaluated at baseline and once at each year of the 4 years of follow-up for health status, including body mass index and glycemic status. Participant fitness also was assessed at baseline through a maximal graded exercise test and at years one and four through a submaximal exercise test. The researchers found that in addition to losing more weight, the weight-loss intervention group had greater increases in fitness in years 1 and 4 (20.6% versus 4.9% and 5.3% versus 1.5%, respectively) than those in the education group. Complete remission -- defined as glucose normalization without medication -- was more common among the lifestyle weight-loss participants than the education group (prevalence ratio 6.6), with participants significantly more likely to experience either partial or complete remission in the lifestyle intervention than in the education intervention at years 1 and 4. Return to clinical diabetes status occurred in roughly one-third of the lifestyle intervention group each year (33.1% at year 2, 33.8% at year 3, and 31.6% at year 4) versus around half among participants in the education group (52.4% at year 2, 45.9% at year 3, and 43.8% at year 4). In addition, continuous, sustained remission was significantly more common among weight-loss intervention participants than in the education group at years 2 to 4. The study authors conclude that: “In these exploratory analyses of overweight adults, an intensive lifestyle intervention was associated with a greater likelihood of partial remission of type 2 diabetes compared with diabetes support and education.”
Edward W. Gregg, Haiying Chen, Lynne E. Wagenknecht, Jeanne M. Clark, Linda M. Delahanty, et al, for the Look AHEAD Research Group. “Association of an Intensive Lifestyle Intervention With Remission of Type 2 Diabetes.” JAMA. 2012;308(23):2489-2496.