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.

Conflict of interest statement

Conflict of Interest Disclosures

All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Delehanty reported board membership with Eli Lilly, Boeringer Ingelheim, and Johnson and Johnson and consultancy support from Pfizer. Dr Safford reported receiving consultancy support from diaDexus. No other disclosures were reported.

Figures

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).