Nutritionist calculating body mass index of woman for obesity treatment in a clinic room. Current research shows the gut microbiome may also influence risk for obesity.
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Weight loss by diet and lifestyle can reverse Type 2 diabetes, evidence suggests. Now, new research shows diabetes remission may reduce cardiovascular disease (CVD) risk by 40% and chronic kidney disease (CKD) by 33%.

The study appeared in Diabetologia and was led by Edward Gregg, head of the School of Population Health, RCSI University of Medicine and Health Sciences, Dublin.

Gregg said, “As the first intervention study to associate remission with reduction of diabetes-related complications, this is encouraging news for those who can achieve remission from type 2 diabetes. While our study is also a reminder that maintenance of weight loss and remission is difficult, our findings suggest any success with remission is associated with later health benefits.”

The Look AHEAD study was a multi-centre RCT that compared the effect of a 12-year intensive lifestyle intervention (ILI) with that of diabetes support and education (DSE) on CVD and other long-term health conditions. 

This five-year study recruited and randomized 5145 adults who were overweight or obese (BMI >25 kg/m2 for non-insulin users or BMI >27 kg/m2 for insulin users) aged 45–76 years with type 2 diabetes. The authors conducted an observational post hoc analysis of participants in both groups, classified them based on remission status, and then compared long-term outcomes. Participants were 58% female, and had a mean age of 59 years, a mean duration of diabetes of 6 years, and a mean BMI of 35.8 kg/m2 (in the range of severe obesity). 

The authors defined remission as: taking no diabetes medications and having a glycated haemoglobin (HbA1c) of <48 mmol/mol (6.5%) at a single point in time.

Participants with evidence of any diabetes remission during follow-up had a 33% lower rate of CKD and a 40% lower rate of CVD in analyses adjusting for HbA1c, blood pressure, blood fats, CVD history, diabetes duration and intervention arm, compared to participants without remission. The magnitude of risk reduction was greatest for participants with evidence of longer-term remission.

The team reported three main findings: First, although 18% of participants achieved remission at some point during follow-up, the percentage of participants with current remission had decreased to three percent by the 8th year of the study, underlining the challenges of keeping weight off using lifestyle interventions. 

Second, despite the relatively short-lived durations of most episodes of remission, the any emission was associated with 33% and 40% lower rates of CKD and CVD, respectively, compared with participants who did not achieve remission. Risk reduction was even greater (55% and 49%, respectively) among those who had evidence of at least 4 years of remission. 

Third, and lastly, participants with a short duration of diabetes were most likely to experience remission. The authors conclude that the associations they found “may be explained by post-baseline improvements in weight, fitness, HbA1c and LDL (bad) cholesterol.”

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