Type 2 diabetes remission 1 year after an intensive lifestyle intervention: A secondary analysis of a randomized clinical trial

Abstract

Aim To investigate whether an intensive lifestyle intervention induces partial or complete type 2 diabetes (T2D) remission. Materials and methods In a secondary analysis of a randomized, assessor‐blinded, single‐centre trial, people with non‐insulin‐dependent T2D (duration <10 years), were randomly assigned (2:1, stratified by sex, from April 2015 to August 2016) to a lifestyle intervention group (n = 64) or a standard care group (n = 34). The primary outcome was partial or complete T2D remission, defined as non‐diabetic glycaemia with no glucose‐lowering medication at the outcome assessments at both 12 and 24 months from baseline. All participants received standard care, with standardized, blinded, target‐driven medical therapy during the initial 12 months. The lifestyle intervention included 5‐ to 6‐weekly aerobic and combined aerobic and strength training sessions (30‐60 minutes) and individual dietary plans aiming for body mass index ≤25 kg/m2. No intervention was provided during the 12‐month follow‐up period. Results Of the 98 randomized participants, 93 completed follow‐up (mean [SD] age 54.6 [8.9] years; 46 women [43%], mean [SD] baseline glycated haemoglobin 49.3 [9.3] mmol/mol). At follow‐up, 23% of participants (n = 14) in the intervention and 7% (n = 2) in the standard care group met the criteria for any T2D remission (odds ratio [OR] 4.4, 95% confidence interval [CI] 0.8‐21.4]; P = 0.08). Assuming participants lost to follow‐up (n = 5) had relapsed, the OR for T2D remission was 4.4 (95% CI 1.0–19.8; P = 0.048). Conclusions The statistically nonsignificant threefold increased remission rate of T2D in the lifestyle intervention group calls for further large‐scale studies to understand how to implement sustainable lifestyle interventions among people with T2D.

Low Carbohydrate Dietary Approaches for People With Type 2 Diabetes—A Narrative Review

“…Until recently it was not known or accepted that Type 2 diabetes remission was possible at all (12), suggesting that standard dietary management approaches are not effective for achieving this. Although there is now evidence that Type 2 diabetes remission is possible with a number of approaches [including Mediterranean (166) and low fat diets (167)(168)(169)], the evidence is strongest for very low energy diets (129,170) and VLCDs (38,130). The former of these methods, very low energy diets, is different in nature to a VLCD however as it is only a short-term approach; thus a long-term, sustainable dietary approach still needs to be adopted after the weight loss phase to ensure any weight that has been lost is not regained, which would almost inevitably lead to the return of Type 2 diabetes.…”

Motivation and Barriers to Maintaining Lifestyle Changes in Patients with Type 2 Diabetes after an Intensive Lifestyle Intervention (The U-TURN Trial): A Longitudinal Qualitative Study

“…The U-TURN trial, a 12-month lifestyle intervention including high exercise volume and dietary counselling was successful in reducing glucose-lowering medications in 73.5% of patients in the intervention group [ 14 ]. At one-year follow-up, the study showed that remission was achieved and maintained in a group with short disease history (a small subgroup of 14 patients out of 64) [ 15 ]. In general, few patients sustain lifestyle modifications and a meta-analysis indicates that the positive outcomes achieved decline after a trial ends [ 2 ].…”

“…To avoid relapse of the disease, maintenance of behavioural changes is essential. Adherence to lifestyle interventions is a specific challenge for future programmes, as concluded by a three-year follow-up of the Finnish Diabetes Prevention Study [ 5 ], while the U-TURN trial concluded that “further studies on maintaining a lifestyle change are needed” [ 15 ]. It is clearly difficult to sustain long-term lifestyle changes [ 7 , 16 , 17 ].…”

The Effect of a Lifestyle Intervention on Type 2 Diabetes Pathophysiology and Remission: The Stevenshof Pilot Study

“…Even though most participants achieved substantial weight loss, remission was achieved by two participants, or 13% of the study population. Higher remission numbers have been reported previously [ 41 , 42 ], although some caution should be taken in directly comparing remission numbers across studies due to differences in the definitions used for T2D remission [ 18 ]. Additionally, our study population is relatively small compared to some landmark trials.…”