Association of an Intensive Lifestyle Intervention With Remission of Type 2 Diabetes

By Edward W. Gregg, Haiying Chen, Lynne E. Wagenknecht, Jeanne M. Clark, L. Delahanty, J. Bantle, Henry J. Pownall, Karen C. Johnson, Monika M. Safford, A. Kitabchi and 3 more. Journal of the American Medical Association (JAMA), 2012

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Context The frequency of remission of type 2 diabetes achievable with lifestyle intervention is unclear. Objective To examine the association of a long-term intensive weight-loss intervention with the frequency of remission from type 2 diabetes to prediabetes or normoglycemia. Design, Setting, and Participants Ancillary observational analysis of a 4-year randomized controlled trial (baseline visit, August 2001–April 2004; last follow-up, April 2008) comparing an intensive lifestyle intervention (ILI) with a diabetes support and education control condition (DSE) among 4503 US adults with body mass index of 25 or higher and type 2 diabetes. Interventions Participants were randomly assigned to receive the ILI, which included weekly group and individual counseling in the first 6 months followed by 3 sessions per month for the second 6 months and twice-monthly contact and regular refresher group series and campaigns in years 2 to 4 (n=2241) or the DSE, which was an offer of 3 group sessions per year on diet, physical activity, and social support (n=2262). Main Outcome Measures Partial or complete remission of diabetes, defined as transition from meeting diabetes criteria to a prediabetes or nondiabetic level of glycemia (fasting plasma glucose <126 mg/dL and hemoglobin A1c <6.5% with no antihyperglycemic medication). Results Intensive lifestyle intervention participants lost significantly more weight than DSE participants at year 1 (net difference, −7.9%; 95% CI, −8.3% to −7.6%) and at year 4 (−3.9%; 95% CI, −4.4% to −3.5%) and had greater fitness increases at year 1 (net difference, 15.4%; 95% CI, 13.7%–17.0%) and at year 4 (6.4%; 95% CI, 4.7%–8.1%) (P<.001 for each). The ILI group was significantly more likely to experience any remission (partial or complete), with prevalences of 11.5% (95% CI, 10.1%–12.8%) during the first year and 7.3% (95% CI, 6.2%–8.4%) at year 4, compared with 2.0% for the DSE group at both time points (95% CIs, 1.4%–2.6% at year 1 and 1.5%–2.7% at year 4) (P<.001 for each). Among ILI participants, 9.2% (95% CI, 7.9%–10.4%), 6.4% (95% CI, 5.3%–7.4%), and 3.5% (95% CI, 2.7%–4.3%) had continuous, sustained remission for at least 2, at least 3, and 4 years, respectively, compared with less than 2% of DSE participants (1.7% [95% CI, 1.2%–2.3%] for at least 2 years; 1.3% [95% CI, 0.8%–1.7%] for at least 3 years; and 0.5% [95% CI, 0.2%–0.8%] for 4 years). Conclusions In these exploratory analyses of overweight adults, an intensive lifestyle intervention was associated with a greater likelihood of partial remission of type 2 diabetes compared with diabetes support and education. However, the absolute remission rates were modest. Trial Registration clinicaltrials.gov Identifier: NCT00017953

Subfields: Endocrinology, Diabetes and Metabolism, Surgery

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