Association of an Intensive Lifestyle Intervention With Remission of Type 2 Diabetes
Edward W. Gregg, PhD; Haiying Chen, PhD; Lynne E. Wagenknecht, DrPH; Jeanne M. Clark, MD, MPH; Linda M. Delahanty, MS, RD; John Bantle, MD; Henry J. Pownall, PhD; Karen C. Johnson, MD, MPH; Monika M. Safford, MD; Abbas E. Kitabchi, MD, PhD; F. Xavier Pi-Sunyer, MD; Rena R. Wing, PhD; Alain G. Bertoni, MD, MPH; for the Look AHEAD Research Group
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
