A real-world trial of type 2 diabetes patients has produced surprising, but gratifying, outcomes
Diabetes experts are hailing the results of a new study showing one in two patients were “cured” of their type 2 diabetes with a GP-led program of diet and lifestyle changes alone.
The results should pave the way for this kind of weight-loss intervention to become routine care for patients looking to reverse their type 2 diabetes, the authors wrote.
“Just less than a quarter of participants in the intervention group achieved weight loss of 15kg or more at 12 months, half maintained more than a 10kg loss, and almost half had remission of diabetes, off antidiabetic medication,” the authors wrote.
“Our findings confirm that type 2 diabetes of up to six years’ duration is not necessarily a permanent, lifelong condition.”
To determine whether intensive weight loss could achieve remission of type 2 diabetes within a normal general practice, the authors recruited around 300 primary care patients who had the condition for six years or less, and randomised them into either normal treatment or supervised weight management.
Those in the weight-loss group were taken off their diabetes medication and put on a low energy diet replacement formula consisting of around 850 kilocalories per day to kickstart the weight loss. After three to five months, participants began reintroducing food under the supervision of a nurse or dietician who transitioned them back on to regular food over the space of two to eight weeks.
Participants were also asked to maintain their normal exercise routines, but not to increase it, during the meal-replacement phase. However, once they began eating food again the investigators provided participants with strategies to increase activity and a goal of reaching 15,000 steps per day.
These strategies appeared to be fruitless however, as there was no statistical difference between activity levels between groups.
Before initiating the study, the authors set a 22% remission rate as the marker for success, so the 46% remission rate was a surprising, but gratifying, result.
While bariatric surgery has been shown to achieve remission in up to 75% of patients, the authors said the sheer number of people with type 2 diabetes “makes it impossible to offer surgery to all people, even if this approach were financially possible and palatable to everyone”.
Diet and lifestyle was a cheaper and potentially safer option, they said.
Remission was also closely linked to the amount of weight patients lost over the year of the study. Those who lost 15kgs or more achieved remission in 86% of cases, as did three out of four participants who lost at least 10kgs.
The authors said this study stood apart from previous investigations because of its real-world rollout, under the guidance of non-specialists.
Associate Professor Sof Andrikopoulos, CEO of the Australian Diabetes Society, said the results strongly supported their first-line recommendations for diabetes: lifestyle modifications of diet and exercise.
Nevertheless, it would take a dedicated primary care practice to be able to offer this service to patients given the time and resources needed to oversee such intensive weight loss for a year or more, he added.
While any intervention that reduced or delayed the diabetes burden was likely to improve cardiometabolic outcomes of patients even in the long-term, it was vital to maintain weight loss and not simply achieve it temporarily, he said.
In addition, because of the effect weight loss has on reducing blood pressure, patients in the study were also taken off their diuretic and antihypertensive drugs and only restarted if systolic blood pressure exceeded 140mm Hg. As a result, two in three remained off their anti-hypertensives at 12 months.
Patients in the intervention group also reported significantly higher outcomes on quality of life measures, whereas this was unchanged in the control group.
Lancet 2017; online 5 December
