Intensive Diabetes Intervention May Cure Disease, Sometimes

Overweight diabetes type 2 patients who take part in an intensive weight loss program are more likely to experience total or partial partial remission of their disease, researchers from the Centers for Disease Control and Prevention, Atlanta, reported in JAMA (Journal of the American Medical Association).

The authors added that an intensive intervention program, which includes counseling, exercise and targets to bring down calorie intake produced "modest absolute remission rates" in type 2 diabetes.

The authors wrote as background information:

"Diabetes traditionally has been considered a progressive, incurable condition wherein the best case scenario after diagnosis is tight metabolic and risk factor management to forestall vascular and neuropathic complications."

Some studies that focused on bariatric surgery have indicated that diabetes type 2 patients who are obese may be cured. A recent study showed that although gastric bypass surgery can help treat obesity, it cannot cure diabetes. "Patients diagnosed as having type 2 diabetes frequently ask their physicians whether their condition is reversible, and some physicians may provide hopeful advice that lifestyle change can normalize glucose levels. However, the rate of remission of type 2 diabetes that may be achieved using non-surgical approaches has not been reported."

We know that lifestyle changes can help people with pre-diabetes avoid ever developing diabetes type two. Little is known what impact intensive interventions might have on patients who already have the disease.

Edward W. Gregg, Ph.D. and team carried out a study to determine what impact an intensive lifestyle intervention might have on partial or complete remission of type 2 diabetes.

They gathered and analyzed data on a 4-year randomized, controlled trial (baseline visit, August 2001-April 2004; last follow-up, April 2008) which compared an ILI (intensive lifestyle intervention) with a DSE (diabetes support and education control condition). All the 4,503 participants were adults and had a BMI (body mass index) of at least 25 and had type 2 diabetes.

The volunteers were randomly assigned into one of two groups:

• ILI (intensive lifestyle intervention) - 2,241 participants. This included counseling which was done individually and in groups every week during the initial six months, and then three times per month during the following six months. During years two to four there were twice monthly contacts, as well as regular refresher group series and campaigns.
  
  The aim was to reduce total calorie intake to 1,200-1,800 per day, through reductions in the consumption of saturated fat. Participants aimed to complete 175 minutes of exercise each week. To assist dietary targets, liquid meal replacements were provided.


• DSE (diabetes support and education control condition) - 2,262 participants. This included three group sessions annually on diet, physical activity and social support

Below are some of the results of the study:

• The ILI group
  
  In 1 year participants lost 8.6% of bodyweight, and 4.7% by the end of the fourth year
  In 1 year participants had a 20.6% increase in fitness, and 4.9% by the end of year 4
  The prevalence of complete remission was much more common in the ILI group
  The absolute prevalence of complete remission was 1.3% (relatively low), and 0.7% at the end of four years


• The DSE group
  
  In 1 year participants lost 0.7% of body weight and 0.8% by the end of the fourth year
  In 1 year participants had a 5.3% increase in fitness, and 1.5% by the end of year 4
  The prevalence of complete remission in this group was considerably lower than in the ILI group
  The absolute prevalence of complete remission was 0.1% at the end of 1 year and 0.2% at the end of 4 years

Complete remission means glucose normalization without having to use medication.

Any type of remission, partial or complete, occurred in 11.5% of ILI participants at end of year 1 and 7.3% at end of year 4, compared to 2% in the DSE groups at both 1 and 4 years.

Remission rates were much higher among:

• People who lost a great deal of weight
• People who became considerably fitter
• People with shorter duration of extant diabetes (those who had not had diabetes for long)
• People with lower HbA_1c at entry and not using insulin

The authors wrote: "The ILI group was significantly more likely to have continuous, sustained remission, as 9.2 percent experienced at least a 2-year remission (vs. for DSE, 1.7 percent) at some point during follow-up, 6.4 percent had at least a 3-year remission (vs. DSE, 1.3 percent), and 3.5 percent had a continuous 4-year remission (vs. DSE, 0.5 percent). The results from the complete case analyses were similar.

"The increasing worldwide prevalence of type 2 diabetes, along with its wide-ranging complications, has led to hopes that the disease can be reversed or prevented. These analyses of more than 4,500 overweight adults with type 2 diabetes confirm that complete remission associated with an intensive life-style intervention, when defined by glucose normalization without need for drugs, is rare. However, partial remission, defined as a transition to prediabetic or normal glucose levels without drug treatment for a specific period, is an obtainable goal for some patients with type 2 diabetes."

The future of diabetes prevention and treatment - Editorial

Patrick J. O'Connor, M.D., M.A., M.P.H., of the HealthPartners Institute for Education and Research, Minneapolis, and David E. Arterburn, M.D., M.P.H., of the Group Health Research Institute, Seattle, in an Accompanying Editorial in the same journal wrote:

"Evidence-based and cost-effective diabetes prevention strategies should be more broadly applied using the full range of available technologies and incentives."

But that is not enough. Research, education, and policy efforts need to be 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. Prevention of diabetes and obesity should be a rallying cry for all clinicians who care about the health of the nation."

Written by Christian Nordqvist

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