Intensive lifestyle intervention associated with partial remission of type 2 diabetes

An intensive lifestyle intervention was associated with partial remission of type 2 diabetes when compared with diabetes support and education, according to a new study.

Researchers performed an ancillary observational analysis using data from the Look AHEAD (Action for Health for Diabetes) study, a four-year randomized, controlled trial sponsored by the National Institutes of Health that compared an intensive lifestyle intervention with diabetes support and education in overweight U.S. adults with type 2 diabetes. The Look AHEAD study was designed to examine whether weight loss decreased incidence of cardiovascular disease but was stopped early, in October 2012, when no such decrease was seen in the intervention versus the control group. The main outcome measure in the current study was partial or complete diabetes remission, which was defined as transition to a prediabetes or nondiabetic glycemia level after meeting diabetes criteria. The study results were published in the Dec. 19 Journal of the American Medical Association.

A total of 4,503 adults from the Look AHEAD sample were included in this analysis. The mean age was 59 years, and the mean body mass index at baseline was 35.8 kg/m². Median time since diabetes diagnosis was five years. Those randomly assigned to the intensive intervention (n=2,241) received weekly group and individual counseling for the first six months of the trial, then three sessions per month for the next six months along with twice-monthly contact and regular refreshers in the next two to four years. Those assigned to the control group (n=2,262) were offered three group sessions per year addressing diet, physical activity and social support.

Patients in the intensive lifestyle group had lost significantly more weight at year 1 and year 4 compared with the control group (net differences, −7.9% and −3.9%; P<0.001) and also had a significantly greater increase in fitness (net differences, 15.4% and 6.4%; P<0.001). Partial or complete diabetes remission was significantly more common in the intervention group than in the control group at year 1 and year 4 (prevalence, 11.5% vs. 2.0% and 7.3% vs. 2.0%, respectively; P<0.001 for each comparison). Rates of continuous, sustained remission for at least two, at least three, and four years were 9.2% (95% CI, 7.9% to 10.4%), 6.4% (95% CI, 5.3% to 7.4%), and 3.5% (95% CI, 2.7% to 4.3%) in the intervention group and 1.7% (95% CI, 1.2% to 2.3%), 1.3% (95% CI, 0.8% to 1.7%), and 0.5% (95% CI, 0.2% to 0.8%) in the control group.

The authors said that their analyses should be considered exploratory since the Look AHEAD study did not include diabetes remission as one of its primary objectives. In addition, they noted that they did not examine the mechanism by which the intervention may have affected glycemic levels. Despite these and other limitations, they concluded that their findings indicate a potential association between an intensive lifestyle intervention and partial diabetes remission in some patients with type 2 disease.

The authors of an accompanying editorial agreed that such intervention could have benefit, especially in patients with early diabetes, but noted that major cardiovascular events and death do not appear to be affected. “Perhaps future analyses…will identify subgroups of patients with type 2 diabetes that may warrant intensive lifestyle or medical intervention to reduce cardiovascular risk,” they wrote. “However, a more potent intervention—bariatric surgery—already appears to achieve what intensive medical and lifestyle intervention cannot: reducing cardiovascular events and mortality rates among severely obese patients with type 2 diabetes.”