5-Year Diabetes Remission: Lancet Study Shows High Success with Weight Loss
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5-Year Diabetes Remission: Lancet Study Shows High Success with Weight Loss
Diabetes in Remission for 5 Years! Lancet Sub-Journal: Weight Loss Over 10 Kilograms, Remission Rate Up to 75%!
Previous extensive research has shown that weight management can slow the progression of type 2 diabetes, improve patients’ blood sugar levels, and reduce their need for glucose-lowering medications.
The DiRECT trial was the “first” study to focus on diabetes remission (defined as a glycated hemoglobin [HbA1c] level of less than 6.5% without glucose-lowering medications) as the primary endpoint, with results confirming that dietary replacement (nutritional meal replacement) and lifestyle interventions can reverse the course of type 2 diabetes, overturning people’s understanding of the disease.
Recently, The Lancet Diabetes & Endocrinology published the 5-year follow-up results of the DiRECT trial. The analysis results indicate that weight loss from dietary intervention could help diabetes patients achieve long-term remission.
The longer patients maintain weight loss and type 2 diabetes remission, the less likely they are to develop diabetes-related complications. Notably, among patients who achieved diabetes remission at the end of the original study’s second year, 26% remained in remission at the fifth year.
The DiRECT trial was a 2-year, open-label, cluster-randomized, controlled trial. In the intervention group, patients used low-calorie nutritional meal replacements (liquid diet, 825-853 calories/day, consisting of 59% carbohydrates, 13% fat, 26% protein, and 2% fiber) for 3-5 months, gradually transitioning back to a normal diet over 2-8 weeks, and discontinued glucose-lowering and blood pressure medications.
The trial found that among patients with type 2 diabetes of less than 6 years duration and not receiving insulin therapy, 46% achieved type 2 diabetes remission within 12 months through the weight management program. Additionally, at months 12 and 24 of the intervention, over 80% of patients experienced weight loss exceeding 15 kg; analysis at 24 months showed that about 75% of patients with type 2 diabetes who lost more than 10 kg were in remission in the first and second years.
It is worth emphasizing that clinicians have traditionally viewed type 2 diabetes as a disease that is difficult to cure and requires lifelong medication. However, recent research, including the DiRECT trial, suggests that type 2 diabetes is associated with excessive and abnormal accumulation of body fat and is a potentially reversible disease (especially early-stage type 2 diabetes). Currently, type 2 diabetes remission is recognized as an achievable management goal.
In the initial DiRECT study, 149 patients were randomly assigned to the intervention group and another 149 to the control group. After the 2-year follow-up of the DiRECT trial, 101 out of 149 patients in the intervention group (68%) chose to continue receiving low-intensity dietary intervention for an additional 3 years (every 3 months). Among them, 95 patients were included in the DiRECT extended intervention group, and the remaining 54 were included in the non-extended intervention group. The current publication of the DiRECT extension study assessed whether continuing low-intensity dietary intervention for up to the fifth year could help patients maintain weight loss and type 2 diabetes remission and improve clinical outcomes.
Overall, the average ages of patients in the extended intervention group (n=95) and the non-extended intervention group (n=54) were 49.6 and 54.8 years, respectively; the durations of diabetes were 2.9 and 3.1 years, respectively; and the body mass indexes were 35.5 and 34.9 kg/m2, respectively.
From the start of the original study, patients in the extended intervention group had an average weight loss of 6.1 kg at the fifth year.
Statistical data show that patients in the extended intervention group experienced an average weight loss of 12.1 kg from baseline in the first year; there was a slight increase in weight in the second, third, and fourth years compared to the first year; however, patients in the extended intervention group maintained stable weight in the fifth year and had a weight loss of 6.1 kg compared to baseline. Compared to the non-extended intervention group, patients in the extended intervention group had a more significant decrease in weight from baseline.
Furthermore, from the start of the original study, patients in the extended intervention group had an average decrease in HbA1c of 11.0 mmol/mol in the first year (after stopping glucose-lowering medications); in the second year, patients in the extended intervention group had an HbA1c level 7.7 mmol/mol lower than baseline; in the third, fourth, and fifth years, patients in the extended intervention group had HbA1c levels 1.9 mmol/mol, 2.9 mmol/mol, and 5.5 mmol/mol higher than baseline, respectively. Compared to the non-extended intervention group, patients in the extended intervention group had a more significant decrease in HbA1c from baseline.
Among patients who achieved remission in the second year, 26% remained in remission at the fifth year.
Overall, 62% of patients in the extended intervention group achieved remission in the first year, which decreased to 13% in the fifth year. It is worth noting that 48 patients who achieved remission in the second year were followed up in the fifth year, among whom 26% remained in remission. These patients who remained in remission in both the second and fifth years had an average weight loss of 8.9 kg.
In addition, 46% of patients in the extended intervention group had a weight loss of more than 10 kg from baseline in the first year, and 75% of these patients were in remission. Conversely, in the fifth year, 19% of patients in the extended intervention group had a weight loss of more than 10 kg from baseline, and 14% of these patients were in remission. Compared to the non-extended intervention group, a higher proportion of patients in the extended intervention group had a weight loss of more than 10 kg from baseline and were in remission.
Analysis of follow-up visits showed that compared to the non-extended intervention group, patients in the extended intervention group had a significantly increased likelihood of achieving HbA1c<6.5% (36% vs. 17%; p=0.0004), discontinuing glucose-lowering medications (62% vs. 30%; p<0.0001), and achieving remission (34% vs. 12%; p<0.0001).
In conclusion, the 5-year follow-up results of the DiRECT study suggest that weight management may help delay or prevent the occurrence of clinical complications of diabetes.
Additionally, although not all patients can achieve diabetes remission through diet alone, new glucose-lowering medications (such as glucagon-like peptide-1 [GLP-1] receptor agonists) may offer more effective options for weight management in these patients.
Combining weight management strategies from the DiRECT study with these new glucose-lowering medications may further reduce the disease burden of patients with type 2 diabetes in the future.
5-Year Diabetes Remission: Lancet Study Shows High Success with Weight Loss
References
[1] Michael EJ Lean et al. 5-year follow-up of the randomized Diabetes Remission Clinical Trial (DiRECT) of continued support for weight loss maintenance in the UK: an extension study. The Lancet Diabetes & Endocrinology (2024). Doi : 10.1016/S2213-8587(23)00385-6
(source:internet, reference only)
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