Abstract
Partial or complete remission from type 2 diabetes was recently observed after bariatric surgeries. Limited data is available about the possibility of inducing diabetes remission through intensive weight reduction. We retrospectively evaluated diabetes remissions after one year of the Weight Achievement and Intensive Treatment (Why WAIT) program, a 12-week intensive program for diabetes weight management in real-world clinical practice. Among 120 obese patients with type 2 diabetes who completed the program, 88 patients returned for follow-up at one year. Nineteen patients (21.6%) had major improvement in their glycemic control, defined as achieving an A1C <6.5% after one year. Four patients (4.5%) achieved either partial or complete diabetes remission defined as A1C <6.5% and <5.7%, respectively, on no antihyperglycemic medications for one year; 2 achieved partial remission (2.3%) and 2 achieved complete remission (2.3%). At the time of intervention, patients who achieved diabetes remission had shorter diabetes duration (<5 years) and lower A1C (<8%) and were treated with fewer than 2 oral medications. They achieved a weight reduction of >7% after 12 weeks. These results indicate that a subset of obese patients with type 2 diabetes is appropriate for intensive lifestyle intervention with the aim of inducing diabetes remission.
Highlights
Type 2 diabetes has been considered as an incurable chronic disease
Since weight gain plays a vital role in the pathophysiology of type 2 diabetes, especially among genetically susceptible individuals [4], there is an urgent need to reexamine the actual value of weight loss as a major component of type 2 diabetes management
One meta-analysis showed that 60– 90% of type 2 diabetes appears to be related to obesity or weight gain and that weight loss of 10% of initial body weight dramatically improves glycemic control and reduces other comorbid risk factors [5]
Summary
Type 2 diabetes has been considered as an incurable chronic disease. Traditionally, the focus of clinical management has been directed toward controlling hyperglycemia and its consequent complications [1]. We demonstrated that modest weight reduction of about 7% over 6-month period through caloric reduction and increased physical activity improves insulin sensitivity, endothelial function, and several markers of inflammation and coagulation in obese patients with and without diabetes [6, 7]. Another meta-analysis of long-term effects of weight loss on diabetes prevention among obese people showed that intentional weight loss reduces risk of developing diabetes by 25%, while larger weight loss achieved through surgical interventions showed a dramatic risk reduction of about 63% [8]. It aimed at characterizing those patients who are likely to achieve remission after weight loss
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