Achieved Diabetes Remission Research Articles

Metformin continuation post-metabolic bariatric surgery and relapse of diabetes.

To evaluate the association of metformin continuation with relapse of diabetes after metabolic bariatric surgery (MBS) in patients with type 2 diabetes and obesity who achieved an HbA1c level of less than 6.5%. This observational, retrospective cohort study included Clalit Health Service members aged 24 years or older with obesity and diabetes, who were treated with metformin, underwent MBS during 2005-2020 and achieved an HbA1c level of less than 6.5% up to 6 months after surgery (index date). Patients who continued metformin treatment (> 2 prescriptions filled, n = 122) after the index date were matched (1:2) on age, sex and HbA1c level at index date and compared with those who stopped treatment (no filled prescriptions, n = 244). The outcome was relapse of diabetes as measured by an HbA1c level of 6.5% or higher (yes/no). The two matched groups maintained a mean HbA1c level of less than 6.5% during the follow-up (mean ~ 5 years). An adjusted Cox proportional hazards model revealed no significant association of metformin continuation after MBS with relapse of diabetes (adjusted hazard ratio = 1.70, 95% confidence interval: 0.98-2.94). No significant differences were observed between the two groups in weight loss and filled prescriptions for other diabetes medications during the follow-up period. Among individuals living with obesity and diabetes who achieved diabetes remission post-MBS, metformin continuation was not associated with relapse of diabetes. This lack of an association indicates that metformin did not provide an additional benefit for maintaining glycaemic control or weight reduction during an average of 5 years postsurgery.

Interventions to improve glycaemic control in people living with, and at risk of developing type 2 diabetes.

Type 2 diabetes mellitus is one of the most prevalent health conditions worldwide, affecting millions of individuals and posing significant public health challenges. Understanding the nature of type 2 diabetes, its causes, symptoms and treatments is crucial for managing and preventing its complications. Many different dietary strategies are used by individuals to treat and manage diabetes. This review provides an overview of popular dietary strategies that have evidence for improving long-term glycaemic control or achieving diabetes remission, as well as strategies that may be useful to reduce postprandial hyperglycaemia, which may be of use in the prevention of diabetes, but also as strategies for those already diagnosed but trying to manage their condition better. Recent clinical trials have provided evidence that in people living with type 2 diabetes who also live with overweight or obesity, using a total diet replacement weight loss programme results in significant and substantial weight loss, and as a result, many people can achieve remission from their diabetes. There has been considerable interest in whether similar effects can be achieved without reliance on formula foods, using real diet approaches. Reduced or low-carbohydrate diet approaches hold some promise, with observational or preliminary findings suggesting beneficial effects, but evidence from robust trials or systematic reviews of randomized controlled trials is still lacking. The Mediterranean dietary pattern, low in saturated fat and high in monounsaturated fat, also has some potential, with evidence to suggest some people can lose weight and achieve remission using this approach, which may be easier to adhere to longer term than more intensive total diet replacement and low-carbohydrate strategies. Plant-based diets that advocate for the elimination of animal-based and/or animal-derived foods have increased in popularity. There is evidence from epidemiological studies that people who follow these diets have a lower risk of developing type 2 diabetes, and evidence from trials and systematic reviews of trials that changing to a dietary pattern lower in animal-based and animal-derived foods has benefits on glycaemic control and other markers of cardiovascular disease. While these approaches all provide food or nutrient prescriptions, approaches that incorporate periods of fasting do not provide rules on the types of foods that can or cannot be consumed, but rather provide time windows of when to eat. Evidence suggests that these approaches can be as effective in achieving energy restriction and weight loss as approaches that advocate continuous energy restriction, and there is evidence for benefits on glycaemic control independent of weight loss. Finally, popular dietary strategies that may be useful to use or combine to help prevent postprandial hyperglycaemia include reducing the glycaemic index or glycaemic load of the diet, high-fibre diets, eating foods in a meal in the order vegetables > protein > carbohydrates, preloading or combining acids such as vinegar or lemon juice with meals and engaging in low-intensity aerobic exercise immediately after meals.

Reassessing type 2 diabetes in adolescents and its management strategies based on insulin resistance.

With changes in lifestyle behaviors, including dietary structure and habits, the prevalence of Youth-onset Type 2 Diabetes Mellitus (YODM) has increased 2 to 3 times compared to 30 years ago. YODM patients experience complications earlier, progress faster, and exhibit more severe symptoms. However, limited and inconclusive direct evidence, coupled with poor patient compliance, poses challenges in the clinical management of YODM. Apart from the continuous decline in pancreatic β-cell function and quantity, tissue-specific insulin resistance (IR) is also a typical characteristic of YODM. The main mechanisms of IR in YODM involve different aspects such as obesity, dietary imbalance, abnormal substance metabolism, chronic inflammation, oxidative stress, and hormonal fluctuations during adolescence. For the comprehensive management of YODM, besides achieving good control of blood glucose levels, it may be necessary to apply the most appropriate methods considering the uniqueness of the patient population and the specifics of the disease. Early identification and detection of the disease are crucial. Precise screening of patients with well-functioning pancreatic insulin β-cells, primarily characterized by IR and obesity, represents the population most likely to achieve diabetes remission or reversal through lifestyle modifications, medications, or even surgical interventions. Additionally, considering potential emotional disorders or the impact of adolescent hormones in these patients, health education for patients and caregivers is essential to make them aware of the long-term benefits of well-controlled blood glucose. In conclusion, adopting comprehensive management measures to achieve diabetes remission or reversal is the ideal goal. Controlling high blood glucose, obesity, and other risk factors related to diabetes complications is the next priority to delay the occurrence and progression of complications. A comprehensive perspective on IR provides insights and references for identifying YODM and its management strategies.

Oral glucose tolerance test clearance in type 2 diabetes patients who underwent remission following intense lifestyle modification: A quasi-experimental study.

Achieving diabetes remission (HbA1c<48mmol/mol without the use of anti-diabetic medication for 3 months) might not assure restoration of a normal glycemic profile [fasting blood sugar level <5.6 mmol/L and Post-Prandial (PP) blood glucose <7.8mmol/L]. The study investigates the factors associated with OGTT clearance in patients under type 2 diabetes remission. Four hundred participants who achieved remission during a one-year online structured lifestyle modification program, which included a plant-based diet, physical activity, psychological support, and medical management (between January 2021 and June 2022), and appeared for the OGTT were included in the study. OGTT clearance was defined by fasting blood glucose < 5.6 mmol/L and 2-hour post-prandial blood glucose <7.8 mmol/L post-consumption of 75g glucose solution. Of the 400 participants, 207 (52%) cleared OGTT and 175 (44%) had impaired glucose tolerance (IGT). A shorter diabetes duration (<5 years) was significantly associated with OGTT clearance (p<0.05). Pre-intervention use of glucose-lowering drugs showed no association with OGTT clearance (p<0.1). Post-intervention, the OGTT-cleared group showed significantly higher weight loss (p<0.05) and a decrease in HbA1c compared to the IGT group (p<0.05). Improvement in Insulin resistance and β-cell function was also higher in the OGTT-cleared group compared to the IGT group (p<0.05). In conclusion, clearing the OGTT is a possibility for those achieving remission through lifestyle interventions. Higher weight loss, a shorter duration of diabetes, and improvement in insulin resistance were significantly associated with OGTT clearance in participants in remission. Future randomized controlled trials with longer follow-ups may help substantiate our findings.

Fresh start with high hopes: a qualitative evaluation of experiences of the Total Diet Replacement phase of the NHS Low Calorie Diet Programme pilot

Background: The National Health Service (NHS) Low Calorie Diet (LCD) programme in England aims to support people with type 2 diabetes (T2DM) to lose weight, improve glycaemic parameters and potentially achieve diabetes remission. The programme pilot launched in 2020 using three different delivery models: one-to-one, group and digital via an App. Service users begin the programme with 12 weeks of Total Diet Replacement (TDR). This study aims to understand the experience of this TDR phase from the service user perspective. Methods: This was a co-produced qualitative longitudinal and cross-sectional study, underpinned by a realist informed approach using semi-structured interviews and photovoice techniques. Service users (n=45) from the NHS LCD programme were recruited across the three delivery models and 21 pilot sites in England. Data were analysed using a thematic approach. Results: Participant demographics were representative of the overall LCD pilot population sample and included experiences from a mix of delivery models and providers. Three themes were presented chronologically. 1) life pre-LCD: the LCD programme was viewed as an opportunity to reset eating behaviours and improve quality of life; 2) experience of TDR: flexibility in allowing supplementary non-starchy vegetables and adapting the flavour and texture of TDR products supported adherence; 3) looking ahead to food reintroduction: at the end of the TDR phase, weight and glycaemia had reduced, while subjective energy levels and mobility improved. Some participants were concerned about progressing to the food reintroduction phase and the possibility of weight regain. Conclusions: The paper reports insight from the TDR phase of the LCD programme. The co-production of this work has resulted in several recommendations for policy and practice which have informed the national roll out of the programme.

Liver fat as a dietary target by Chinese Medical Nutrition Therapy (CMNT) diet for treating type 2 diabetes with non-alcoholic fatty liver disease: study protocol for a randomised controlled trial

IntroductionType 2 diabetes and non-alcoholic fatty liver disease (NAFLD) often coexist and increase risk for developing liver fibrosis and diabetes complications if no effective measures are taken. Dietary intervention is...

Ketogenic diet combined with intermittent fasting: an option for type 2 diabetes remission?

With increasing attention to diabetes remission, various special dietary patterns have been found to be effective in achieving diabetes remission. The effect of a single dietary pattern on lowering blood glucose is clear, but studies on the synergistic effects of different dietary patterns are limited. This article describes the types of intermittent fasting and ketogenic diets, potential mechanisms, contraindications of combination diets, recommendations for combination diets, and their health outcomes. This paper aims to illustrate the evidence for intermittent fasting combined with a ketogenic diet on outcomes of diabetes remission and effect on blood glucose control. Knowledge of these findings can help doctors and patients determine dietary patterns for achieving diabetes remission and understanding their application.

Telomere Maintenance Is Associated with Type 2 Diabetes Remission in Response to a Long-Term Dietary Intervention without Non-Weight Loss in Patients with Coronary Heart Disease: From the CORDIOPREV Randomized Controlled Trial.

In order to evaluate whether telomere maintenance is associated with type 2 diabetes remission, newly diagnosed type 2 diabetes patients without glucose-lowering treatment (183 out of 1002) from the CORDIOPREV study (NCT00924937) were randomized to consume a Mediterranean or low-fat diet. Patients were classified as Responders, those who reverted from type 2 diabetes during the 5 years of dietary intervention (n = 69), and Non-Responders, who did not achieve diabetes remission by the end of the follow-up period (n = 104). We found no differences in diabetes remission between the two diets, and we determined telomere length (TL) by measuring qPCR, telomerase activity using the TRAP assay, and direct redox balance based on the ratio of reduced glutathione (GSH) to oxidized glutathione (GSSH) via colorimetric assay. Responders exhibited higher baseline TL in comparison with Non-Responders (p = 0.040), and a higher TL at baseline significantly predicted a higher probability of type 2 diabetes remission (OR 2.13; 95% CI, 1.03 to 4.41). After the dietary intervention, Non-Responders showed significant telomere shortening (-0.19, 95% CI -0.32 to 0.57; p = 0.005). Telomere shortening was significantly pronounced in type 2 diabetes patients with a worse profile of insulin resistance and/or beta-cell functionality: high hepatic insulin resistance fasting, a high disposition index (-0.35; 95% CI, -0.54 to -0.16; p < 0.001), and a low disposition index (-0.25; 95% CI, -0.47 to -0.01; p = 0.037). In addition, changes in TL were correlated to the GSH/GSSG ratio. Responders also showed increased telomerase activity compared with baseline (p = 0.048), from 0.16 (95% CI, 0.08 to 0.23) to 0.28 (95% CI, 0.15 to 0.40), with a more marked increase after the dietary intervention compared with Non-Responders (+0.07; 95% CI, -0.06-0.20; p = 0.049). To conclude, telomere maintenance may play a key role in the molecular mechanisms underlying type 2 diabetes remission in newly diagnosed patients. However, further larger-scale prospective studies are necessary to corroborate our findings.

A novel model for predicting diabetes remission after bariatric surgery based on the measurement of C-peptide and creatinine in serum: A pilot study

Background and aimsBariatric surgery is effective for treating type 2 diabetes (T2D) in patients with obesity, although a significant proportion of these patients do not achieve diabetes remission after the surgery even after significant weight loss and metabolic improvement. C-peptide is a valuable marker of beta cell function and insulin secretion, but renal function must be considered when interpreting measurements in patients with T2D. The study aims to investigate the association of serum levels of C-peptide adjusted for creatinine with diabetes remission and glycemic target achievement after bariatric surgery in patients with obesity and T2D. Methods and resultsProspective data from a cohort of 84 patients with obesity and T2D submitted to Roux-en-Y gastric bypass (RYGB) were collected at baseline and at least a 6-month follow up. A multivariate binomial regression model showed that Ln(C-peptide/creatinine) and age were significantly associated with 6-month T2D remission. The area under the curve for the receiver operating characteristic analysis (AUROC) to predict remission was 0.87, and more accurate than the AUROC based on C-peptide levels alone (0.75). The same model was also able to predict achieving an HbA1c target of 7 % (53 mmol/mol) (AUROC 0.96). ConclusionIn conclusion, Ln(C-peptide/creatinine) ratio could be a useful tool in predicting T2D remission and target achievement after RYGB surgery, providing a more accurate reflection of beta cell function in bariatric patients.

The metabolomic signature of weight loss and remission in the Diabetes Remission Clinical Trial (DiRECT)

Aims/hypothesisHigh-throughput metabolomics technologies in a variety of study designs have demonstrated a consistent metabolomic signature of overweight and type 2 diabetes. However, the extent to which these metabolomic patterns can be reversed with weight loss and diabetes remission has been weakly investigated. We aimed to characterise the metabolomic consequences of a weight-loss intervention in individuals with type 2 diabetes.MethodsWe analysed 574 fasted serum samples collected within an existing RCT (the Diabetes Remission Clinical Trial [DiRECT]) (N=298). In the trial, participating primary care practices were randomly assigned (1:1) to provide either a weight management programme (intervention) or best-practice care by guidelines (control) treatment to individuals with type 2 diabetes. Here, metabolomics analysis was performed on samples collected at baseline and 12 months using both untargeted MS and targeted 1H-NMR spectroscopy. Multivariable regression models were fitted to evaluate the effect of the intervention on metabolite levels.ResultsDecreases in branched-chain amino acids, sugars and LDL triglycerides, and increases in sphingolipids, plasmalogens and metabolites related to fatty acid metabolism were associated with the intervention (Holm-corrected p<0.05). In individuals who lost more than 9 kg between baseline and 12 months, those who achieved diabetes remission saw greater reductions in glucose, fructose and mannose, compared with those who did not achieve remission.Conclusions/interpretationWe have characterised the metabolomic effects of an integrated weight management programme previously shown to deliver weight loss and diabetes remission. A large proportion of the metabolome appears to be modifiable. Patterns of change were largely and strikingly opposite to perturbances previously documented with the development of type 2 diabetes.Data availabilityThe data used for analysis are available on a research data repository (https://researchdata.gla.ac.uk/) with access given to researchers subject to appropriate data sharing agreements. Metabolite data preparation, data pre-processing, statistical analyses and figure generation were performed in R Studio v.1.0.143 using R v.4.0.2. The R code for this study has been made publicly available on GitHub at: https://github.com/lauracorbin/metabolomics_of_direct.Graphical

Reduction of Plasma BCAAs following Roux-en-Y Gastric Bypass Surgery Is Primarily Mediated by FGF21.

Type 2 diabetes (T2D) is a challenging health concern worldwide. A lifestyle intervention to treat T2D is difficult to adhere, and the effectiveness of approved medications such as metformin, thiazolidinediones (TZDs), and sulfonylureas are suboptimal. On the other hand, bariatric procedures such as Roux-en-Y gastric bypass (RYGB) are being recognized for their remarkable ability to achieve diabetes remission, although the underlying mechanism is not clear. Recent evidence points to branched-chain amino acids (BCAAs) as a potential contributor to glucose impairment and insulin resistance. RYGB has been shown to effectively lower plasma BCAAs in insulin-resistant or T2D patients that may help improve glycemic control, but the underlying mechanism for BCAA reduction is not understood. Hence, we attempted to explore the mechanism by which RYGB reduces BCAAs. To this end, we randomized diet-induced obese (DIO) mice into three groups that underwent either sham or RYGB surgery or food restriction to match the weight of RYGB mice. We also included regular chow-diet-fed healthy mice as an additional control group. Here, we show that compared to sham surgery, RYGB in DIO mice markedly lowered serum BCAAs most likely by rescuing BCAA breakdown in both liver and white adipose tissues. Importantly, the restored BCAA metabolism following RYGB was independent of caloric intake. Fasting insulin and HOMA-IR were decreased as expected, and serum valine was strongly associated with insulin resistance. While gut hormones such as glucagon-like peptide-1 (GLP-1) and peptide YY (PYY) are postulated to mediate various surgery-induced metabolic benefits, mice lacking these hormonal signals (GLP-1R/Y2R double KO) were still able to effectively lower plasma BCAAs and improve glucose tolerance, similar to mice with intact GLP-1 and PYY signaling. On the other hand, mice deficient in fibroblast growth factor 21 (FGF21), another candidate hormone implicated in enhanced glucoregulatory action following RYGB, failed to decrease plasma BCAAs and normalize hepatic BCAA degradation following surgery. This is the first study using an animal model to successfully recapitulate the RYGB-led reduction of circulating BCAAs observed in humans. Our findings unmasked a critical role of FGF21 in mediating the rescue of BCAA metabolism following surgery. It would be interesting to explore the possibility of whether RYGB-induced improvement in glucose homeostasis is partly through decreased BCAAs.

Weight Loss Versus Glycemic Control as the Primary Treatment Target in Newly Diagnosed Type 2 Diabetes: Why Choose When You Can Have Both?

Weight loss has been associated with significant improvements in glycemic control, quality of life, and comorbidities in people with type 2 diabetes. Furthermore, achieving diabetes remission can reduce the risk of microvascular complications and mitigate the burden of diabetes on healthcare systems. However, preventing weight regain is challenging in the long term. Strict glycemic control, particularly in the early stages of the disease, can reduce the subsequent risk of microvascular complications and specific macrovascular endpoints in the long run; however, its impact on cardiovascular and all-cause mortality remains controversial. New classes of antidiabetic agents, namely glucagon-like peptide 1 receptor agonists and sodium-glucose cotransporter 2 inhibitors, have been shown to reduce cardiorenal risk and induce weight loss, in addition to effectively lowering blood glucose with a minimal risk of hypoglycemia. Recently, it has been debated whether weight loss or glycemic control should be the first priority in people with a recent diagnosis of type 2 diabetes. This article aims to discuss the debate from a clinical perspective, evaluate the advantages and disadvantages of each therapeutic strategy, and assess the impact of both approaches on the future risk of diabetic complications, based on the latest evidence. Given that both goals are equally important, the authors suggest that merging the two strategies, with the early and aggressive use of combination therapies consisting of glucagon-like peptide 1 receptor agonists and sodium-glucose cotransporter 2 inhibitors, will confer maximum benefits in terms of weight loss and glycemic control, and will reduce the future risk of complications from diabetes. A personalized approach that takes into account specific patient characteristics, including age, sex, race, frailty, and cognitive status, among others, can lead to more effective diabetes care.

Time Restricted Eating may induce diabetes remission

Intermittent fasting diets, also known as Time Restricted Eating (TRE) have become popular in recent years as an effective weight loss method. TRE is a form of chrono nutrition that focuses on limiting calorie intake to a shortened “eating window”, followed by a prolonged fasting period (e.g. 8 hour feeding window, 16 hour fasting period). Initial time-restricted feeding studies on diet-induced obesity in mice demonstrated improved weight loss and metabolic parameters when eating duration was limited to 8 hours or less. TRE has since been investigated in humans with some evidence for effectiveness in reducing bodyweight and improving certain cardio-metabolic parameters. In this study, researchers conducted a 3-month TRE diet intervention among 36 people with diabetes and found almost 90% of participants, including those who took blood sugar-lowering agents and insulin, reduced their diabetes medication intake after TRE. Fifty-five percent of these people experienced diabetes remission, discontinued their diabetes medication and maintained it for at least one year. Importantly, sixty-five percent of the study participants who achieved diabetes remission had a diabetes duration of more than 6 years – disease duration >6 years was an exclusion criteria in the DIRECT study which reported diabetes remission following a Very Low calorie Diet programme. Overall this study provided preliminary evidence of efficacy of TRE for diabetes remission. It would be interesting to have a randomised controlled study of VLCD vs TRE with a primary outcome measure being rate of diabetes remission. The study was published in the Endocrine Reviews and received funding from the National Natural Science Foundation of China.

Abstract P352: A Review of Trials Designed to Achieve Diabetes Remission With Lifestyle Intervention Alone: Implications for Sub-Saharan Africa

Introduction: As the prevalence of type 2 diabetes (T2D) in sub-Saharan Africa rises and pharmacological hypoglycemics are often unavailable or prohibitively expensive, the ability to induce T2D remission through medication-free lifestyle interventions (LSI) needs urgent assessment. Objective: This scoping review evaluated trials designed to induce T2D remission by LSI without hypoglycemic medications. Methods: Using a combination of controlled vocabulary terms and key words specific to each database, PubMed, Embase, Cochrane, and CINAHL databases were searched for trials designed induce diabetes remission through LSI alone and were published before September 16, 2021. Of the 928 identified, 63 duplicates were removed. After title and abstract review, 727 irrelevant articles were excluded. After full-text review 112 inappropriate articles were removed. The remaining 26 articles described 16 trials. So each trial would be represented by one article, the latest publication from each trial was included. Of the 16 trials, 7 trials were on newly-diagnosed, treatment-naïve T2D and 9 trials were on established T2D with LSI initiated after discontinuation of medications. Results: The 16 trials were published between 1984 and 2021. They were conducted in 10 different countries. None were conducted in Sub-Saharan Africa. Median number of participants was 180 and 20 for the newly-diagnosed and established T2D respectively. Median duration was 5 years for newly-diagnosed T2D and 5 months for established T2D. For newly-diagnosed T2D, LSI involved dietary counseling with or without calorie restriction (~1500 kcal/d) and exercise. For established T2D trial the main focus was dietary intervention most often divided into 3 phases; Phase 1: low-calorie meal replacement; Phase 2: food re-introduction; and Phase 3: weight maintenance. Median remission rate for the 16 trials was 55%. The consensus across trials was with or without exercise, T2D remission requires diet modification and weight loss. Predictors of remission were: higher BMI and lower A1C at enrollment, shorter T2D at enrolment, and a 10% loss of baseline weight. Nonglycemic benefits of LSI included improved blood pressure, renal function and lipid profile as well as enhanced quality of life. Conclusions: LSI without medications can induce remission in both newly-diagnosed and established T2D. In sub-Saharan Africa, LSI as the initial therapeutic option needs exploration.

Diabetes remission of bariatric surgery and nonsurgical treatments in type 2 diabetes patients who failure to meet the criteria for surgery: a systematic review and meta-analysis

BackgroundThe efficacy of bariatric surgery in moderate and severe obesity patients to reach diabetes remission is clear, but for mild obesity patients, the choice of surgical and non-surgical treatment is still unclear. This study we aim to compare the effect of surgical and nonsurgical treatment on patients BMI < 35 kg/m2 to reach diabetes remission.MethodWe searched relevant articles publish between Jan 1,2010 and Jan 1, 2023 in the following databases: Embase, PubMed/MEDLINE, Scopus, and Cochrane Library. We got the OR, MD and P-value using random effect model to compare the efficiency between bariatric surgery and nonsurgical treatment on diabetes remission, the reduction of BMI, Hb1Ac and FPG.ResultsIn 7 included studies including 544 participants, bariatric surgery is more effective than non-surgical treatment to reach diabetes remission [OR 25.06, 95%CL 9.58–65.54]. Bariatric surgery more likely resulted in significant reductions in HbA1c [MD -1.44, 95%CL (-1.84)-(-1.04)] and FPG [MD -2.61, 95%CL (-3.20)-(-2.20)]. Bariatric surgery may resulted in reductions in BMI [MD -3.14, 95%CL (-4.41)-(-1.88)], which more significant in Asian.ConclusionIn type 2 diabetes patients who BMI < 35 kg/m2, bariatric surgery is more likely to achieve diabetes remission and better blood glucose control than nonsurgical treatment.

The association between the reduction of body weight and new-onset type 2 diabetes remission in middle-aged Japanese men: Population-based Panasonic cohort study 8.

This study aimed to investigate the association between change in body weight (BW) and type 2 diabetes remission in Japanese men with new-onset type 2 diabetes. This study enrolled 1,903 patients with new-onset type 2 diabetes between 2008 and 2013 from a medical health checkup program conducted by the Panasonic Corporation, Osaka, Japan. The baseline was defined as the year of new-onset diabetes. We assessed the type 2 diabetes remission five years after baseline and the association between the change in BW and type 2 diabetes remission using logistic regression analyses. To evaluate the predictive performance of the change in BW, we employed the receiver operating characteristic curves and the area under the receiver operating characteristic (ROC) curve (AUC). The BW loss was associated with type 2 diabetes remission in the participants with a BMI ≥25 kg/m2 but not in the participants with a BMI <25 kg/m2. The odds ratios were 1.96 (95% CI: 1.19-3.29) and 3.72 (95% CI: 2.14-6.59) in the participants with a loss of 5-9.9% and loss of ≥10% for five years, respectively, in the participants with a BMI ≥25 kg/m2 (reference; stable group [0.9% gain to 0.9% loss]). The AUC and cut-off values for the rate of change in BW for type 2 diabetes remission were 0.59 and 5.0%. Body weight loss of ≥5% effectively achieved diabetes remission in Japanese men with a BMI ≥25 kg/m2 and new-onset type 2 diabetes.

The effectiveness of lifestyle interventions for diabetes remission on patients with type 2 diabetes mellitus: Asystematic review and meta-analysis.

Conventional wisdom affirmed that diabetes was irreversible, but current research shows that lifestyle interventions may achieve diabetes remission among patients with type 2 diabetes mellitus. Recently, many original studies have examined the effectiveness of lifestyle interventions. However, great heterogeneity in intervention approaches resulted in inconsistent intervention effects. The aim of this study was to determine the effectiveness of lifestyle interventions for diabetes remission among patients with type 2 diabetes mellitus. PubMed, CINAHL, Embase, Web of Science Core Collection, and Cochrane Library were searched for relevant articles from their inceptions to March 26, 2021. Reference lists and a relevant journal were searched manually as well. Both randomized controlled trials and quasi-experimental studies were included. The quantitative data extracted from the selected studies included diabetes remission rate, weight, and quality of life score. The risk of bias was assessed by the Cochrane and Joanna Briggs Institute's tool. RevMan version 5.3. was used to carry out the meta-analysis. This systematic review included 12 studies involving 3997 patients with type 2 diabetes mellitus. Lifestyle interventions included in the studies were mainly divided into diet-only interventions and diet combined with physical activity interventions. Among them, there were three types of diet: (1) low-energy diet, (2) low carbohydrate diet, and (3) Mediterranean diet. Moderate-intensity aerobic and resistance physical activity, walking, and maintaining habitual physical activity were the three types of physical activity interventions employed in the included studies. The results indicated that lifestyle interventions were effective for achieving diabetes remission, reducing weight, and improving quality of life in patients with type 2 diabetes mellitus. Lifestyle interventions were associated with significant effects on diabetes remission, reducing weight, and improving quality of life. As an important part of lifestyle interventions, diet and physical activity have a significant effect on blood glucose and weight control in patients with type 2 diabetes mellitus. It is therefore suggested that the contents of lifestyle interventions should focus on diet and physical activity.

Comparing the acceptability of total diet replacement and food-based low energy diets for type 2 diabetes remission amongst South Asians: a public and patient involvement activity.

With type 2 diabetes prevalence rising, low energy diets (total diet replacement and food-based low energy diets) are increasingly used to induce weight loss and achieve diabetes remission. The effectiveness of these diets has been primarily tested in the UK white population but not in the south Asian population at high risk of diabetes. Obtaining the opinion of members of the community on what would constitute a culturally acceptable diet is essential for successful interventions aiming to achieve diabetes remission in south Asians. We organised two patient and public involvement activities in the North West of England to understand views of people from the south Asian population on whether low energy diets (850 Kcal) in the form of total diet replacement or food-based meals, are acceptable dietary interventions to achieve type 2 diabetes remission. Thirteen people, with either type 2 diabetes or having someone with diabetes in the family attended a virtual or a face-to-face meeting. Low energy total diet replacement in the form of soups and shakes was considered unacceptable, while there was a preference for a culturally tailored low energy food-based diet. Ready-made portion controlled catered meals were suggested as a likely approach to improve adherence. This work provided valuable insights to shape a future study looking at the feasibility of a catered meal low-energy dietary intervention to induce T2D remission in primary care within the south Asian population.

Abstract 14842: Concordance Between the Various Cardiovascular Risk Scores: Six Months Results of the Randomised Clinical Trial Evaluating Whole-Body Digital Twin Technology Enabled Precision Nutrition for Remission of Diabetes

Introduction: The Twin Precision Treatment (TPT) intervention uses the Whole-Body Digital Twin Platform, with AI and the Internet of Things, to integrate multi-dimensional data to give precision nutrition and health recommendations via the TPT app and by coaches Methods: We compared the differences between the cardiovascular (CV) risk scores: (ASCVD (atherosclerotic cardiovascular disease) risk score, QRISK, and Framingham risk score (FRS) in the TWIN intervention arm (T) (n=203) and control group (C) (n=80) along with the changes in glycemic and extra glycemic parameters Results: Mean age (years) in T and C was 43.4 (±8.2) and 50.9 (±10.6); respectively. Mean duration of diabetes (years) in T and C was 3.7 (±2.6) and 4.7 (±2.8); respectively. There was a significant reduction in all three risk scores in T arm with glycemic and other extra glycemic parameters (Table). In the intervention arm, the mean difference in the ASCVD score (%) from baseline to 180 days was comparable in the group that achieved remission (AR) (n=170) -5.3 (±5.7, 95% CI -6.2 to -4.4) and the group that did not achieve remission (DAR) (n=33) -3.9 (±4, 95% CI -5.3 to -2.5) (p=019 ns). Similarly, the mean difference in the QRISK score (%) from baseline to 180 days was comparable in AR -3.3 (±5.1, 95% CI -4.1 to -2.5) and DAR -5.1 (±6.7, 95% CI -7.6 to -2.7), (p=0.07 ns). Mean difference in the FRS (%) from baseline to 180 days was comparable in AR -9.2 (±7.4, 95% CI -10.4 to -8.1) and DAR -7.4 (±6.9, 95% CI -9.8 to -4.9), (p=0.18 ns). On day 180 Kappa agreement between ASCVD and QRISK was 0.32, between QRISK and FRS was 0.63, and between ASCVD and FRS was 0.43. Conclusions: The significant reduction in all three CV risk scores at three months was sustained at six months. TPT yields a significant reduction in cardiovascular risk across the three risk scores and is independent of the achievement of remission of diabetes. TPT, apart from achieving diabetes remission, has independent benefits for the reduction of cardiovascular risk.

RF28 | PSUN184 New American Diabetes Association Definition of Diabetes Remission Does not Correlate with Time in Remission in Ketosis-Prone Diabetes

Abstract Introduction Approximately 50% of obese Black patients presenting with diabetic ketoacidosis (DKA) at new-onset of diabetes have immunologic and metabolic features of type 2 diabetes, also called ketosis-prone diabetes (KPDM). With intensive insulin treatment, ∼70% have improvements in beta-cell function and insulin sensitivity and achieve diabetes remission. The definition of remission in KPDM has been heterogeneous with our group defining remission as HbA1c &amp;lt; 7%, fasting blood glucose (BG) &amp;lt; 130 mg/dl and random BG &amp;lt; 180 mg/dl while off insulin injections for at least 1 week. In 2021, the American Diabetes Association (ADA) consensus recommended that the definition of diabetes remission as HbA1c &amp;lt; 6.5% or a fasting BG &amp;lt; 126 mg/dl while off medications for &amp;gt; 3 months. We hypothesized that patients who achieved the more intensive ADA definition of remission (HbA1c &amp;lt; 6.5%) will have longer time in remission compared to our previous non-intensive definition of remission (HbA1c 6.5-7%). Methods Forty obese Black patients (BMI ≥ 28 kg/m2) with newly diagnosed diabetes and unprovoked DKA had intensive insulin therapy until HbA1c &amp;lt; 7% without insulin therapy for at least one week. Patients were followed until hyperglycemia relapse (HbA1c &amp;gt; 6.5% or fasting BG &amp;gt; 126 mg/dl and/or requiring antidiabetic medications). Baseline characteristics and clinical time to hyperglycemia relapse-free survival were compared between patients with HbA1c &amp;lt; 6.5 (n= 24) and HbA1c 6.5-7% (n=16). Results Age, sex, family history of type 2 diabetes, BMI, HbA1C, weight change and insulin doses received between the two groups (HbA1c &amp;lt; 6.5 vs 6.5-7%) did not differ significantly. Median follow-up overall was 404 days with a range of 7-1099 days. In patients that experienced a hyperglycemia relapse, bivariate analysis shows that median days to hyperglycemia relapse was longer in HbA1c &amp;lt; 6.5% (411 days, range (17-804) vs HbA1c 6.5-7% (126 days, range (7-391), p= 0.05) but without a statistical difference. Survival analysis showed that time in remission did not statistically differ between the two groups (log rank, p=0.6853). Conclusion In obese Black patients with KPDM, HbA1c &amp;lt; 6.5% at time of insulin discontinuation does not prolong diabetes compared to patients that achieved HbA1c 6.5-7%, suggesting that predictors of prolonged remission may differ among diverse populations with diabetes. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m., Monday, June 13, 2022 12:44 p.m. - 12:49 p.m.