Association of an intensive lifestyle intervention with remission of type 2 diabetes

Abstract

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.

Figure 1

Participant Flow

Figure 2

Prevalence of Any Remission (Partial or Complete) by Intervention Condition and Year Data are prevalence and 95% CIs for any remission (partial or complete). Estimates are based on sample with multiple imputation (n=4503). In complete case analysis (year 1: n = 4327; year 2: n=4191; year 3: n=4168; year 4: n=4098), prevalence estimates with raw cases/denominators were as follows: for intensive lifestyle intervention, year 1: 11.5% (95% CI, 10.1%–12.8%) (247/2157); year 2: 10.4% (95% CI, 9.1%–11.7%) (218/2090); year 3: 8.7% (95% CI, 7.5%–9.9%) (181/2083); and year 4: 7.3% (95% CI, 6.2%–9.4%) (150/2056); for diabetes support and education, year 1: 2.0% (95% CI, 1.4%–2.6%) (43/2170); year 2: 2.3% (95% CI, 1.6%–2.9%) (48/2101); year 3: 2.2% (95% CI, 1.6%–2.8%) (46/2085); and year 4: 2.0% (95% CI, 1.5%–2.7%) (41/2042).

Figure 3

Duration of Any Remission (Partial or Complete) by Intervention Group and Duration of Sustained Remission Data are estimates and 95% CIs based on sample with multiple imputation (n=4503). Estimates from complete case analysis of persons with no missing data element at any single year (n=3713) were as follows: for intensive lifestyle intervention, year 1: 14.6% (95% CI, 13.0%–16.2%) (271/1852); year 2: 8.2% (95% CI, 6.8%–9.2%) (148/1852); year 3: 5.8% (95% CI, 4.7%–6.8%) (107/1852); and year 4: 3.4% (95% CI, 2.6%–4.2%) (63/1852); for diabetes support and education, year 1: 4.3% (95% CI, 3.4%–5.2%) (80/1861); year 2: 1.6% (95% CI, 1.0%–2.1%) (29/1861); year 3: 1.2% (95% CI, 0.7%–1.7%) (22/1861); and year 4: 0.4% (95% CI, 0.1%–0.7%) (8/1861).