Role of weight loss in prediabetes remission examined
Whether patients had remission of prediabetes in response to an intensive lifestyle intervention was not determined by whether they lost weight, a post hoc analysis of a trial in Germany found. Those who achieved remission did have different distribution of their adipose tissue, however.
Prediabetes remission is achievable with intensive lifestyle intervention even if it does not result in weight loss, a study found.
Researchers conducted a post hoc analysis of the Prediabetes Lifestyle Intervention Study, an ongoing multicenter study that recruited individuals with prediabetes in study centers throughout Germany. Participants received the intervention for 12 months and were followed for up to nine years with metabolic phenotyping. Of the 1,105 individuals originally included, 234 (21.2%) did not lose or gained weight during the year of the intervention. Of these, 51 (21.8%) returned to normal glucose regulation (defined by the study authors as being a responder). Results were published Sept. 29 in Nature Medicine.
A comparison of trajectories during the one-year intervention period between those who had remission of prediabetes and those who did not showed that changes in body mass index were similar, maximal aerobic capacity did not differ between groups, and adherence to dietary advice based on food diaries was not different. Habitual physical activity score and daily distance walked as well as lean body mass did not differ between groups during intervention and follow-up. “Taken together, these data show that prediabetes remission without weight loss compared to nonremission was independent of weight trajectories, overall body composition and physical fitness,” the authors wrote.
Differences between groups included that glucose concentrations determined by oral glucose tolerance tests (OGTT) were lower in those who had remission and decreased over time in that group but not in those who did not respond. Consecutive insulin concentrations during OGTT were higher in nonresponders before, during, and after the intervention. Subcutaneous adipose tissue increased more in responders, showing that with weight gain, responders predominantly stored additional energy subcutaneously while nonresponders gained visceral fat, the study authors said. “These data highlight that lipid deposition during weight gain is most likely a crucial factor for improvements in glucose regulation during non-weight-loss prediabetes remission,” they wrote.
The authors concluded that there is a weight-independent component of glycemic status, which is related to body fat distribution. Patients who achieved both prediabetes remission and the guideline-recommended weight loss target of 7% were 76% less likely to develop type 2 diabetes, compared to those who only met the weight loss target, they noted. They emphasized the importance of incorporating glycemic targets into practice guidelines in addition to weight loss targets, noting that “primary treatment goals should focus on achieving metabolic health rather than weight loss alone.”