Type 2 diabetes remission possible with diet, weight loss in primary care
An intensive weight management program delivered in the primary care setting was effective for diabetes remission and weight loss in adults with type 2 diabetes compared with treatment with best-practice care guidelines only, study data show.
“Rather than addressing the root cause, management guidelines for type 2 diabetes focus on reducing blood sugar levels through drug treatments,” Roy Taylor, MD, FRCP, professor of medicine and metabolism at Newcastle University in the United Kingdom, said in a press release. “Diet and lifestyle are touched upon, but diabetes remission by cutting calories is rarely discussed. A major difference from other studies is that we advised a period of dietary weight loss with no increase in physical activity, but during the long-term follow-up increased daily activity is important. Bariatric surgery can achieve remission of diabetes in about three-quarters of people, but it is more expensive and risky, and is only available to a small number of patients.”
Taylor and colleagues evaluated data from the Diabetes Remission Clinical Trial ( DiRECT ) to determine whether weight management delivered in the primary care setting is effective for sustained remission of type 2 diabetes at 12 months. Participants for the study were recruited between July 25, 2014, and Aug. 5, 2017. Participants were randomly assigned to best-practice care guidelines (control; n =149) or a weight management program that included withdrawal of antidiabetic and antihypertensive drugs, total diet replacement, stepped food reintroduction and structured support for long-term weight maintenance ( intervention; n = 149).
Participants in the control group were 38% women, 99% white and aged a mean 55.9 years; they had a mean BMI of 34.2 kg/m2 and mean HbA1c of 7.5%. Participants in the intervention group were 44% women, 98% white, and aged a mean 52.9 years; they had a mean BMI of 35.1 kg/m2 and mean HbA1c of 7.7%. Mean diabetes duration among all participants was 3 years.
Weight loss of 15 kg or more was recorded in 24% of the intervention group and none of the control group at 12 months. Diabetes remission at 12 months was more likely in the intervention group (46%) than the control group (4%; OR = 19.7; 95% CI, 7.8-49.8).
Participants in the intervention group lost more weight than the control group (10 kg vs. 1 kg; P < .0001), and mean HbA1c dropped in the intervention group (-0.9%) whereas it increased in the control group (0.1%; P < .0001). Diabetes remission — that is, no longer requiring antidiabetes medications — occurred among 74% of participants in the intervention group and 18% in the control group.
Nine serious adverse events occurred during the study period, but none led to study withdrawal. “Our findings suggest that the very large weight losses targeted by bariatric surgery are not essential to reverse the underlying processes which cause type 2 diabetes,” Taylor said. “The weight-loss goals provided by this program are achievable for many people. The big challenge is long-term avoidance of weight regain. Follow-up of DiRECT will continue for 4 years and reveal whether weight loss and remission is achievable in the long-term.”
In an accompanying editorial, Matti Uusitupa, MD, PhD, professor emeritus in the Institute of Public Health and Clinical Nutrition at the University of Eastern Finland, wrote that “the DiRECT study indicates that the time of diabetes diagnosis is the best point to start weight reduction and lifestyle changes because motivation of a patient is usually high and can be enhanced by the professional health care providers.”
“However, disease prevention should be maintained as the primary goal that requires both individual-level and population-based strategies, including taxation of unhealthy food items to tackle the epidemic of obesity and type 2 diabetes,” he wrote. – by Amber Cox
Disclosures: Taylor and Uusitupa report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.