Long-term type 2 diabetes remission through weight loss ‘unsustainable’ for most

Only a small proportion of patients are able to sustain remission of their type 2 diabetes by weight loss alone, a study has suggested.

An analysis of more than 37,000 patients enrolled in a risk reduction programme in Hong Kong showed eight years after diagnosis only 6% had achieved lowered blood glucose through weight loss.

Of those who did initially achieve remission – defined as at least two consecutive HbA1c results of under 6.5% at least six months apart and no use of glucose lowering drugs – two thirds had increased blood glucose levels three years later.

However, reporting their findings in in PLOS Medicine, the researchers did note that people with the greatest weight loss in the first year were most likely to have sustained remission.

The results from this ‘real-world’ setting are significantly lower than had been reported in clinical trials where patients may receive more intensive support, they said. But their analysis did not include patients who had undergone bariatric surgery.

It suggested that while it may be possible to reverse a type 2 diabetes diagnosis through weight loss, for most patients doing this without medication may be hard to sustain in the long term.

Early intervention to support patients with weight management strategies may be important since those who had the greatest early weight loss seemed to have the most success, they added.

It follows a recent study in Diabetologia which reported reducing blood glucose through lifestyle changes can lead to substantially reduced risk of cardiovascular disease and chronic kidney disease.

Analysis of data over 12 years from 4500 patients in the US also found very few managed to sustain improvement made through lifestyle changes in the long term.

Study leader Professor Andrea Luk from the Faculty of Medicine at the Chinese University of Hong Kong said greater weight loss within the first year was linked with an increased likelihood of achieving diabetes remission but overall the results suggested ‘poor sustainability of diabetes remission in real-world setting’.

‘Our study provides evidence for policy-makers to design and implement early weight management intervention and diabetes remission initiatives.’

Professor Azeem Majeed, a GP and professor of primary care and public health at Imperial College London, said the study reflected what was seen in clinical practice – that long-term weight loss is hard to sustain.

‘Most people should be informed that they are – in the longer term – likely to need a combination of medical treatment and lifestyle changes to manage their type 2 diabetes even if they manage to achieve remission early on after diagnosis through weight loss,’ he said.

But that didn’t mean that some weight loss would not be beneficial as patients would be likely to need lower doses of oral medication and would be less likely to need insulin. There are also other health benefits to weight loss, he added.

‘The message is that people with type 2 diabetes should view lifestyle measures as a key part of their management and should not rely entirely on medication to manage their condition.’