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Diabetes Remission & Weight Loss

iStock-1477118902Results of a large population-based observational cohort study examining the association between weight loss and diabetes remission were recently published in PLOS Medicine. This Hong Kong-based study included more than 37,000 people recently diagnosed with type 2 diabetes who were followed for a median of 8 years, with a focus on their 1-year weight change after diagnosis and their long-term remission rates.

The authors found that only 6% of people achieved remission (defined as 2 consecutive HbA1c <6.5% and no glucose-lowering medications), but the likelihood of remission was greater with a higher degree of weight loss. For example, there was a more than 3-fold (328%) greater chance of remission with ≥10% weight loss (compared to weight gain), versus only a 34% change when losing between 0-5%. Additionally, approximately 2/3 of people that achieved remission eventually returned to hyperglycemia, again, strongly associated with the degree of weight loss. Remission in this study was associated with a 31% lower all-cause mortality rate.

The authors suggest this large population-based cohort provides important insights, as the controlled conditions in clinical trials may not always accurately reflect real-world dynamics. For example, in a randomized trial, a total diet replacement (as part of an aggressive weight loss strategy) was shown to induce remission in nearly ½ of the participants recently diagnosed with diabetes, compared to only 4% in the control group (an odds ratio of 19.7). Furthermore, in this randomized trial, only 7% of those losing 0-5 kg achieved remission, compared to 86% of those who lost 15kg or more (and none of those who gained weight). These studies both strongly suggest weight loss should be heavily emphasized following a diabetes diagnosis, and that perhaps real-world efforts are not nearly aggressive enough.

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