Recent study results are the primary to indicate that individuals who can “reverse” type 2 diabetes through intensive lifestyle intervention — even when only temporarily — are less more likely to develop heart and kidney disease in later life.
Reversal isn’t a medical term; doctors prefer to make use of the word remission, which, for type 2 diabetes, is defined as when an individual’s A1C — a measure used to observe blood sugar over just a few months — falls below the diabetes range (<6.5 percent) without using blood sugar–lowering medication.
“There’s lots of interest in the thought of remission of type 2 diabetes within the news today. That is the primary study to ask the questions ‘What happens after that? What happens after people achieve remission?’” explains lead creator Edward W Gregg, PhD, professor on the School of Public Health, Imperial College, London.
“The fundamental takeaway is that lifestyle-based efforts to realize type 2 diabetes remission are related to prolonged health advantages long beyond remission,” Dr. Gregg says.
Long-term complications that may end up from living with type 2 diabetes for a few years include damage to the guts, blood vessels, and kidneys and nerve damage that may affect eyesight and cause diabetic neuropathy.
Within the study, called Look AHEAD, those that achieved diabetes remission had a 40 percent lower risk of heart problems and a 33 percent lower risk of kidney disease at the tip of 12 years, based on the brand new report, published in Diabetologia.
That is most definitely as a consequence of the outcomes of weight reduction, improvements in fitness, and lowering of A1C and low-density lipoprotein (LDL, or “bad”) cholesterol in the approach to life intervention arm of the trial, says Gregg.
And the longer that individuals were able to take care of remission, the greater the profit when it comes to diabetes-related risk reduction, he stressed. Those that had evidence of at the very least 4 years of remission had 55 percent and 49 percent reductions in kidney and heart problems, respectively.
“That is the primary study where we’ve shown the prolonged effects of remission on long-term diabetes complications. Our findings are very encouraging.”
Remission Isn’t Easy, but Even Temporary Reprieve Brings Advantages
The Look AHEAD study involved roughly 5,000 individuals with type 2 diabetes, around half of whom were assigned to an intensive lifestyle intervention segment. This consisted of weekly group and individual sessions in the primary six months, to assist participants reduce fat intake and total calorie intake by as much as 1,800 calories per day, and to extend physical activity to around 175 minutes per week. The frequency of the sessions was reduced because the trial continued. By the tip of the trial, participants attended training sessions only every two years.
The remaining half of the participants got “diabetes education and support,” which consisted of three group sessions a yr specializing in food regimen and physical activity goals.
Only 11 percent of the sort 2 diabetes patients within the Look AHEAD study who were assigned to the intervention arm achieved remission one yr into the study. Even fewer, 4 percent, were still in remission at 12 years, the study’s end. Participants with a brief duration of type 2 diabetes, a low starting A1C, and a big magnitude of weight reduction were most definitely to experience remission.
Gregg stresses that remission isn’t easy; neither is it necessarily everlasting.
“The vast majority of patients with type 2 diabetes should not going to realize remission, but they’ll still gain these same health advantages through other means, resembling managing risk aspects well — blood pressure, glycemia (high blood sugar) and cholesterol, stopping smoking and things like that.”
“A healthy lifestyle is nice at any point with type 2 diabetes. It’s going to have a profit whether you achieve remission or not.”
As an illustration, Gregg notes that just a few of the patients within the less intensive “diabetes, education and support arm” of Look AHEAD also achieved remission.
It Doesn’t Matter How Remission Is Achieved
Look AHEAD was began 15 years ago, when doctors first realized that bariatric surgery was in a position to put type 2 diabetes into remission, and so they desired to see if this was possible through lifestyle intervention alone.
Within the years since, research has explored alternative methods of achieving diabetes remission. Other contemporary methods include very low-carbohydrate diets, meal alternative, resembling the protocol for the continued DiRECT trial, or intermittent fasting.
It doesn’t really matter how remission is achieved, Gregg says, stressing that the goal is to remove use of all type 2 diabetes medications.
“[Look AHEAD is] the primary intervention study to associate remission with reduction of diabetes-related complications, and that is encouraging news for many who can achieve remission from type 2 diabetes.”
And remission remains to be essential even when only temporary, he says: “Our findings suggest any success with remission is related to later health advantages.”
Can Ozempic and Mounjaro Create Diabetes Remission?
Asked whether the newer GLP-1 agonist drugs resembling semaglutide (Ozempic) or tirzepatide (Mounjaro) needs to be counted when considering remission, Gregg is circumspect.
GLP-1 agonists appear to supply similar advantages to lifestyle interventions like those studied within the Look AHEAD trial. These drugs, which were first approved for type 2 diabetes for blood sugar reduction, can result in a lack of as much as 15 to twenty percent of body weight — approaching that achieved through bariatric surgery — and have also been shown to protect the guts and kidneys.
Technically, taking a GLP-1 agonist wouldn’t qualify for so-called type 2 diabetes remission since the goal of that’s to remove all blood sugar–lowering medications, he explained.
And although people can now take GLP-1 agonists for obesity only, even in the event that they don’t have diabetes, he quips, “I suppose it’s a judgment call. Whether you call a GLP-1 agonist a diabetes medication or not.” But had GLP-1 agonists been available when Look AHEAD was conducted and a patient was taking one, “we might not have called that remission,” he concludes.