Loading ...

TOPLINE:

• Study participants with type 2 diabetes who achieved remission had substantially lower incidences of chronic kidney disease (CKD) and cardiovascular disease (CVD) than those who didn't achieve remission.
• Longer duration of remission was associated with greater CKD and CVD reduction.

METHODOLOGY:

• Comparison of CKD and CVD incidences between participants in the multicenter Look AHEAD trial randomized to an intensive lifestyle intervention (ILI) with those offered group diabetes support and education (DSE).
• Remission was defined as taking no diabetes medications and having A1c < 48 mmol/mol (6.5%) at a single point in time.
• Of the 5145 participants, 12.7% achieved remission for at least one follow-up visit.

TAKEAWAY:

• Remission prevalence in the ILI vs DSE groups, respectively, at 1, 4, and 12 years were 11.2% vs 2%, 7.2% vs 2.1%, and 3.7% vs 1.95%.
• In a multivariate analysis, participants who experienced any remission had a 33% lower rate of CKD (hazard ratio, 0.67; 95% CI, 0.52-0.87) and a 40% lower rate of CVD (0.60; 0.47-0.79).
• This association had a dose-response relationship, with a significant difference between those who had no remission and those in remission across four or more visits for both CKD (0.45; 0.25-0.82) and CVD (0.51; 0.30-0.89).

IN PRACTICE:

The success of lifestyle-based remission programs remains undetermined.

"On the one hand, these findings may drive a paradigm shift whereby selected subsets of the population are actively encouraged to strive beyond prevention of diabetes and its complications, to regression in risk status, in order to optimize long-term health outcomes. On the other hand, the long-term sustainability of such intensive interventions is unclear, and their incremental benefit above and beyond what may be achieved by targeting optimal risk factor management and more modest weight loss has not been tested in experimental settings. These questions underscore the need for continued follow-up in remission studies, as well as rigorous evaluation of real-world programs of remission as they develop in the future."

SOURCE:

This study was conducted by Edward W. Gregg, PhD, of the Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, and colleagues and published online on January 17, 2024, in Diabetologia.

LIMITATIONS:

Use of an epidemiological rather than clinical definition of remission (due to lack of data). Number of visits with remission used as proxy for actual remission duration. Exclusion criteria led to exclusion of 10% of original sample. Possible bias in that those achieving remission may have pursued more intensive risk management. Underpowered for some analyses. Insufficient data to ascertain explanation for associations found.

DISCLOSURES:

The Look AHEAD study was funded by the US National Institutes of Health.

Miriam E. Tucker is a freelance journalist based in the Washington, DC, area. She is a regular contributor to Medscape Medical News, with other work appearing in the Washington Post, NPR's Shots blog, and Diabetes Forecast magazine. She is on X: @MiriamETucker.