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Association of an Intensive Lifestyle Intervention With Remission of Type 2 Diabetes
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Details:
  • Pubmed ID:
    23288372
  • Pubmed Central ID:
    PMC4771522
  • Funding:
    CC999999/Intramural CDC HHS/United States
    DK 046204/DK/NIDDK NIH HHS/United States
    DK56990/DK/NIDDK NIH HHS/United States
    DK56992/DK/NIDDK NIH HHS/United States
    DK57002/DK/NIDDK NIH HHS/United States
    DK57008/DK/NIDDK NIH HHS/United States
    DK57078/DK/NIDDK NIH HHS/United States
    DK57131/DK/NIDDK NIH HHS/United States
    DK57135/DK/NIDDK NIH HHS/United States
    DK57136/DK/NIDDK NIH HHS/United States
    DK57149/DK/NIDDK NIH HHS/United States
    DK57151/DK/NIDDK NIH HHS/United States
    DK57154/DK/NIDDK NIH HHS/United States
    DK57171/DK/NIDDK NIH HHS/United States
    DK57177/DK/NIDDK NIH HHS/United States
    DK57178/DK/NIDDK NIH HHS/United States
    DK57182/DK/NIDDK NIH HHS/United States
    DK57219/DK/NIDDK NIH HHS/United States
    M01RR000056/RR/NCRR NIH HHS/United States
    M01RR00051/RR/NCRR NIH HHS/United States
    M01RR0021140/RR/NCRR NIH HHS/United States
    M01RR01066/RR/NCRR NIH HHS/United States
    M01RR01346/RR/NCRR NIH HHS/United States
    M01RR02719/RR/NCRR NIH HHS/United States
    P30 DK048520/DK/NIDDK NIH HHS/United States
    P30 DK48520/DK/NIDDK NIH HHS/United States
    U01 DK057131/DK/NIDDK NIH HHS/United States
    UL1 RR 024153/RR/NCRR NIH HHS/United States
    Intramural NIH HHS/United States
  • Document Type:
  • Collection(s):
  • Description:
    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