Overweight patients with type 2 diabetes are usually told by physicians to modify their diets and increase physical activity in the hope of causing the condition to go into remission. But a study appearing today in JAMA suggests that even intensive lifestyle interventions will likely help only a small percentage of patients achieve acceptable blood glucose levels without medication.
Researchers monitored 4503 US adults with type 2 diabetes and a body mass index of 25 or higher for 4 years; participants were randomly assigned to receive long-term intensive weight loss interventions (including group and individual counseling) or traditional diabetes support only. Enrollees in the intensive program lost almost 8% more weight at 1 year and almost 4% more weight at 4 years compared with those receiving traditional support. Nearly 12% of the intensive program enrollees had partial or complete remission at 1 year and 7.3% at 4 years compared with 2% of those receiving traditional support at either year. Only 3.5% of enrollees receiving intensive interventions experienced continuous remission at 4 years, although it was better than the 0.5% receiving traditional support.
The study’s lead author, Edward W. Gregg, PhD, of the US Centers for Disease Control and Prevention, discusses his team’s findings:
news@JAMA: Why did you do the study?
Dr Gregg: We’ve known that maintaining a healthy diet and lifestyle prevents diabetes, but a big question was whether healthy diets and lifestyles could make diabetes go into remission.
news@JAMA: Your findings suggest otherwise.
Dr Gregg: Complete remission was very rare, although it was more common in the intensive intervention group. This is just an indication of how tough it is, once a person has diabetes, to turn it around. There was some good news in our study. We were able to get about 1 in 10 into remission, and for people who had diabetes for a shorter period of time prior to enrollment, 1 in 5 went into remission.
news@JAMA: What would you say to people with type 2 diabetes who are considering giving up on changing their diets and increasing physical activity as measures to combat the condition?
Dr Gregg: You can’t cure diabetes with lifestyle changes, but lifestyle changes with good follow-up care can make a difference in reducing risk for other complications, such as cardiovascular disease and disability.
news@JAMA: Do treating physicians need to give a more nuanced message about lifestyle interventions to their patients with diabetes?
Dr Gregg: Physicians need to be realistic with their patients when talking about the benefits of lifestyle interventions. The message can be that whatever their diabetes status, these lifestyle changes will reduce their risk of getting the bad health outcomes that come with diabetes.
news@JAMA: Do your findings suggest overweight patients with diabetes should consider bariatric surgery first as a more effective treatment to reduce health risks associated with the condition?
Dr Gregg: Even in people who are candidates for bariatric surgery, maintaining a healthy diet and lifestyle will still be important. Bariatric surgery may be appropriate for some people but not for the majority.