The frequency of remission of type 2 diabetes achievable with lifestyle intervention
is unclear.
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.
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.
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).
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).
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.