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94% fail to cure Type 2 diabetes with weight loss alone
JANUARY 23, 20241 COMMENT
by StudyFinds
HONG KONG, China — Weight loss alone often is not enough to permanently cure Type 2 diabetes, a new study contends. According to the research, only six percent of individuals who attempt to manage their diabetes through weight loss remain free of the condition after eight years.

The study, which focused on real-world conditions rather than clinical trials, was conducted by researchers from the Chinese University of Hong Kong. They analyzed data from 37,326 people in Hong Kong who were newly diagnosed with Type 2 diabetes, examining the duration and effectiveness of controlling the disease through weight loss.

Interestingly, the research finds that those who lost the most weight in the first year had a higher likelihood of remaining diabetes-free in subsequent years. However, two-thirds of those who initially succeeded in achieving remission through weight loss experienced elevated blood glucose levels again by the third year.

In contrast to clinical trials, where up to 27 percent of participants managed to combat diabetes through weight loss, this study did not involve clinical intervention. Clinical trials often report higher success rates due to intensive lifestyle interventions, including support for dietary changes, physical exercise, and mental health.

The study concludes that few patients can achieve normal blood glucose levels solely through weight management, especially over the long term. Rapid weight loss in the first year of diabetes diagnosis appears to increase the chances of the lifestyle changes being effective and the condition not reoccurring.

“Greater weight loss within the first year of diabetes diagnosis was associated with an increased likelihood of achieving diabetes remission,” says study author Professor Andrea Luk in a media release. “However, the incidence of diabetes remission was low with only 6% of people achieving remission over 8 years, and half of those with initial remission returned to hyperglycemia within 3 years indicating poor sustainability of diabetes remission in real-world setting.”

1-year weight change after diabetes diagnosis and long-term incidence and sustainability of remission of type 2 diabetes in real-world settings in Hong Kong: An observational cohort study
Hongjiang Wu,Aimin Yang,Eric S. H. Lau,Xinge Zhang,Baoqi Fan,Ronald C. W. Ma,Alice P. S. Kong,Elaine Chow,Wing-Yee So,Juliana C. N. Chan,Andrea O. Y. Luk
Published: January 23, 2024
https://doi.org/10.1371/journal.pmed.1004327

Abstract
Background
Clinical trials have demonstrated that remission of type 2 diabetes can be achieved following sustained weight loss. However, the feasibility of achieving diabetes remission through weight management in real-world settings remains unclear. In this study, we aimed to examine the association of weight change at 1 year after diabetes diagnosis with long-term incidence and sustainability of type 2 diabetes remission in real-world settings in Hong Kong.

Methods and findings
This was a population-based observational cohort study. The territory-wide Risk Assessment and Management Programme for Diabetes Mellitus (RAMP-DM) provides regular comprehensive assessments of metabolic control and complication screening for people with diabetes in Hong Kong. We included 37,326 people with newly diagnosed type 2 diabetes who were enrolled in the RAMP-DM between 2000 and 2017, followed until 2019. Diabetes remission was defined as 2 consecutive HbA1c <6.5% measurements at least 6 months apart in the absence of glucose-lowering drugs (GLDs) and with no record of GLDs at least 3 months before these measurements. During a median follow-up of 7.9 years, 6.1% (2,279) of people achieved diabetes remission, with an incidence rate of 7.8 (95% CI: 7.5, 8.1) per 1,000 person-years. After adjusting for age at diabetes diagnosis, sex, assessment year, body mass index, other metabolic indices, smoking, alcohol drinking, and medication use, the hazard ratio (HR) for diabetes remission was 3.28 (95% CI: 2.75, 3.92; p < 0.001) for people with ≥10% weight loss within 1 year of diagnosis, 2.29 (95% CI: 2.03, 2.59; p < 0.001) for those with 5% to 9.9% weight loss, and 1.34 (95% CI: 1.22, 1.47; p < 0.001) for those with 0% to 4.9% weight loss compared to people with weight gain. During a median follow-up of 3.1 years, 67.2% (1,531) of people who had achieved diabetes remission returned to hyperglycaemia, with an incidence rate of 184.8 (95% CI: 175.5, 194.0) per 1,000 person-years. The adjusted HR for returning to hyperglycaemia was 0.52 (95% CI: 0.41, 0.65; p < 0.001) for people with ≥10% weight loss, 0.78 (95% CI: 0.68, 0.92; p = 0.002) for those with 5% to 9.9% weight loss, and 0.90 (95% CI: 0.80, 1.01; p = 0.073) for those with 0% to 4.9% weight loss compared to people with weight gain. Diabetes remission was associated with a 31% (HR: 0.69, 95% CI: 0.52, 0.93; p = 0.014) decreased risk of all-cause mortality. The main limitation of the study is that the reliability of HbA1c used to define diabetes remission can be affected by other medical conditions. Furthermore, we did not have data on bariatric surgery.

Conclusions
In this study, greater weight loss within the first year of diabetes diagnosis was associated with an increased likelihood of achieving diabetes remission and a decreased risk of returning to hyperglycaemia among those who had achieved diabetes remission. However, both the incidence of diabetes remission and the probability of its long-term sustainability were low with conventional management in real-world settings, in an era when the importance of weight loss was not fully appreciated. Our study provides evidence for policymakers to design and implement early weight management interventions and diabetes remission initiatives.

Author summary
Why was this study done?

-Remission of type 2 diabetes is defined as a return to normal blood glucose levels without the need for pharmacotherapy

-Recent clinical trials have demonstrated that remission of type 2 diabetes can be achieved following sustained weight loss through bariatric surgery or lifestyle interventions.

-However, the feasibility of achieving diabetes remission through weight management and its long-term sustainability in real-world settings remain unclear.

What did the researchers do and find?

-Using data from 37,326 people with newly diagnosed type 2 diabetes from a diabetes complication screening program in Hong Kong, we examined the associations of 1-year weight change (%) after diabetes diagnosis with long-term incidence and sustainability of diabetes remission

-We found only 6% of people achieved diabetes remission during a median follow-up of 8 years. Among people who achieved diabetes remission, 67% of them returned to hyperglycaemia during a median follow-up of 3 years.

-Compared to people who had weight gain, those who had a greater 1-year weight loss (%) after diabetes diagnosis were more likely to achieve diabetes remission and had a decreased risk of returning to hyperglycaemia.

What do these findings mean?

-Remission of type 2 diabetes is achievable in real-world settings, but both the incidence of diabetes remission and the probability of its long-term sustainability are low with conventional management.

-Implementation of early weight management interventions should be considered as diabetes remission initiatives.

-A limitation of the study is that the reliability of HbA1c as a measure for diabetes remission can be influenced by other medical conditions.