Intense lifestyle-based weight-loss interventions were associated with a partial remission of diabetes, researchers found.

Compared with an education and support intervention for diabetes patients, those engaged in an intense weight-loss and lifestyle intervention were more likely to experience any remission at year 1 (11.5% versus 7.3%, P<0.001), and were more likely to see that remission continuously sustained over 3 years of measurements (9.2%, 6.4%, and 3.5% versus 1.7%, 1.3%, and 0.5%, respectively), according to Edward Gregg, PhD, of the Centers for Disease Control and Prevention, and colleagues.

Participants in the intervention group also lost significantly more weight at two follow-up periods (a difference of 7.9% at year one and 3.9% at year four, P<0.001 for both), and significantly fewer participants in the weight-loss intervention who experienced remission returned to clinical diabetes status at each point of follow-up, they wrote online in the Journal of the American Medical Association.

The researchers also noted that the weight-loss intervention was particularly effective in “those whose diabetes is of short duration, who have lower hemoglobin A levels, and who do not yet require insulin therapy.”

Patients diagnosed as having type 2 diabetes frequently ask if their condition is reversible, and “some physicians may provide hopeful advice that lifestyle change can normalize glucose levels,” they wrote in the introduction to their findings. “However, the rate of remission of type 2 diabetes that may be achieved using nonsurgical approaches has not been reported.” To help clarify the issue, the researchers investigated the outcomes of a long-term (4 years) intensive weight-loss intervention on frequency of remission from diabetes to prediabetes or normoglycemia in 2,241 participants and compared 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 participants were 45 to 75 years old with a mean age of 59 years, had a median time since diabetes diagnosis of 5 years, and were “notably obese at baseline.” In addition to losing more weight, the weight-loss intervention group had greater increases in fitness in years one and four (20.6% versus 4.9% and 5.3% versus 1.5%, respectively, P<0.001 for both) 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, 95% CI 3.3 to 13.3, P<0.001). Absolute prevalence of complete remission was low overall, the authors noted. Participants were significantly more likely to experience either partial or complete remission in the lifestyle intervention than in the education intervention at years 1 and 4 (P<0.001 for both). Return to clinical diabetes status occurred in roughly one-third of the lifestyle intervention group each year (33.1% at year two, 33.8% at year three, and 31.6% at year four) versus around half among participants in the education group (52.4% at year two, 45.9% at year three, and 43.8% at year four). In addition, continuous, sustained remission was significantly more common among weight-loss intervention participants than in the education group at years two to four (P<0.001 for all). In an accompanying editorial, David Arterburn, MD, of the Group Health Research Institute in Seattle Wash., and Patrick O'Connor, MD, of the Institute for Education and Research in Minneapolis, Minn., noted that neither intervention translated to "lower rates of nonfatal myocardial infarction, nonfatal stroke, hospitalization for angina, or death compared with conventional diabetes treatment." They editorialists speculated that this was due to overall lower-than-expected rates of cardiovascular events due to improved risk factor control in each group, improved critical care after acute cardiovascular events, a healthier-than-expected cohort, and exclusion of participants with high cardiovascular risk at baseline. They also noted that bariatric surgery achieves an effective reduction in cardiovascular events and mortality rates.