Sustained weight loss may help in sustained diabetes remission: Lancet

Weight loss may help in Diabetes remission and sustained remission was linked to the extent of sustained weight loss.

Restricting to a primary care-led weight loss programme can lead to sustained remissions 2 years later for diabetes patients, finds a new study published in the journal Lancet Diabetes & Endocrinology.

The DiRECT trial assessed type 2 diabetes remission during a primary care-led weight-management programme. At 1 year, 68 (46%) of 149 intervention participants were in remission and 36 (24%) had achieved at least 15 kg weight loss. Prof Michael E J Lean, School of Medicine, Dentistry and Nursing, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK, and colleagues conducted this 2-year analysis to assess the durability of the intervention effect.

The researchers enrolled about 300 patients with type 2 diabetes having a BMI of 27–45 and not insulin independent. Their primary care practices were randomized to deliver either an integrated structured weight management program or standard care. The intervention included diabetes and hypertension drug withdrawal, total diet replacement of 850 calories/day for 12 to 20 weeks, stepped food reintroduction for 2 to 8 weeks, and structured support for maintaining weight loss.

Key Findings:

• At 12 months, 24% of patients in the intervention group had lost 15 kg or more and 46% had diabetes remission.


• At 24 months, 17 (11%) intervention participants and three (2%) control participants had a weight loss of at least 15 kg and 53 (36%) intervention participants and five (3%) control participants had remission of diabetes.


• The adjusted mean difference between the control and intervention groups in change in body weight was −5·4 kg and in HbA _1c was −4·8 mmol/mol, despite only 51 (40%) of 129 patients in the intervention group using anti-diabetes medication compared with 120 (84%) of 143 in the control group.


• In a post-hoc analysis of the whole study population, of those participants who maintained at least 10 kg weight loss (45 of 272 with data), 29 (64%) achieved remission; 36 (24%) of 149 participants in the intervention group maintained at least 10 kg weight loss.


• Serious adverse events were similar to those reported at 12 months but were fewer in the intervention group than in the control group in the second year of the study (nine vs 22).

"Our findings make a strong case that intensive weight management should be included as a first-line option in routine care for people with type 2 diabetes to target early remission from a potentially devastating progressive disease," write the authors. The DiRECT programme sustained remissions at 24 months for more than a third of people with type 2 diabetes.Sustained remission was linked to the extent of sustained weight loss.

For further reference log on to https://doi.org/10.1016/S2213-8587(19)30068-3