(Best Syndication News) - Researchers found that overweight type-2 diabetes patients increased their chances of partial and complete remission with intensive lifestyle intervention. The results, which showed modest remission rates, were reported in the December 19, 2012 issue of JAMA.
Many people diagnosed with type-2 diabetes wonder if the disease is reversible. Diabetes is thought of as a disease that is progressive that will eventually lead to vascular and neuropathic damage. Other studies involving bariatric surgery on type 2 diabetes patients suggested that some cases could be resolved. There were no studies on the rate of remission with lifestyle modifications alone. This prompted Edward W. Gregg, Ph.D., of the Centers for Disease Control and Prevention, Atlanta, and his colleagues to investigate.
The research involved 4,503 adults in the United States with type-2 diabetes and a body mass index of 25 of higher. The participants were randomly assigned to an intensive lifestyle intervention (ILI) group or to a diabetes support and education control group (DSE). The 4-year randomized controlled trial assessed the participants at the baseline visit, August 2001-April 2004; and with the last follow-up visit on April 2008.
The ILI group met as a group and on an individual basis every week for the first six months. Then they altered the schedule to just three meetings per month for the next six months. For years two through four, the ILI participants had twice monthly contact and a regular refresher group series and campaigns.
The ILI group members had a goal to eat around 1,200 to 1,800 calories per day and were to reduce the amount of saturated fat in their diet. They also had to exercise 175 minutes per week. In order to meet dietary goals, the participants were given liquid meal replacements.
The DSE group was offered three group sessions per year to instruct on diet, physical activity and social support.
The ILI group lost the most weight. During the first year, the ILI group lost an average of 8.6 percent of their body weight compared to 0.7 percent in the DSE group. During the fourth year of the study, the ILI group lost 4.7 percent of their body weight compared to 0.8 percent in the DSE group.
The ILI group demonstrated the most improvement in fitness, with a 20.6 percent improvement compared to 5.3 percent in the DSE group during the first year. During the fourth year, the improvement was at 4.9 percent with the ILI group; the DSE group declined by 1.5 percent.
Complete remission occurred more often in the ILI group than in the DSE group. However, the remission rate was modest. The ILI group had an absolute remission rate of 1.3 percent versus 0.1 percent in the DSE group in the first year of the study. After the fourth year, the absolute remission rate was 0.7 percent in the ILI group and 0.2 percent in the DSE group.
When measuring for complete or partial remission, the numbers were still better in the ILI group. The ILI group had an 11.5 percent partial or complete remission rate compared to 2.0 percent for the DSE group (first year). During the fourth year, the ILI group had a partial or complete remission rate of 7.3 percent, while the DSE group remained at 2.0 percent.
The ILI group had the best rates of remaining in remission. The ILI group had 9.2 percent in remission for at least 2 years compared to 1.7 percent in the DSE group. Three years of remission were seen in 6.4 percent of the ILI group compared to 1.3 percent in the DSE group. Four years of remission was seen with 3.5 percent in the ILI group compared to just 0.5 percent in the DSE group.
The researchers conclude that complete remission of type 2 diabetes is rare even with an intensive lifestyle intervention. Complete remission is defined as having normal glucose without a need for medication. Partial remission means the patient was at pre-diabetic or normal glucose level without using medications for a certain time. The researchers suggest that partial remission is an obtainable goal for some people with type 2 diabetes.
By: Marsha Quinn
Ref: JAMA. 2012;308(23):2489-2496; 1
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