Behaviour change, weight loss and remission of Type 2 diabetes: a community‐based prospective cohort study

Abstract

Aim To quantify the association between behaviour change and weight loss after diagnosis of Type 2 diabetes, and the likelihood of remission of diabetes at 5‐year follow‐up. Method We conducted a prospective cohort study in 867 people with newly diagnosed diabetes aged 40–69 years from the ADDITION‐Cambridge trial. Participants were identified via stepwise screening between 2002 and 2006, and underwent assessment of weight change, physical activity (EPAQ2 questionnaire), diet (plasma vitamin C and self‐report), and alcohol consumption (self‐report) at baseline and 1 year after diagnosis. Remission was examined at 5 years after diabetes diagnosis via HbA1c level. We constructed log binomial regression models to quantify the association between change in behaviour and weight over both the first year after diagnosis and the subsequent 1–5 years, as well as remission at 5‐year follow‐up. Results Diabetes remission was achieved in 257 participants (30%) at 5‐year follow‐up. Compared with people who maintained the same weight, those who achieved ≥ 10% weight loss in the first year after diagnosis had a significantly higher likelihood of remission [risk ratio 1.77 (95% CI 1.32 to 2.38; p<0.01)]. In the subsequent 1–5 years, achieving ≥10% weight loss was also associated with remission [risk ratio 2.43 (95% CI 1.78 to 3.31); p<0.01]. Conclusion In a population‐based sample of adults with screen‐detected Type 2 diabetes, weight loss of ≥10% early in the disease trajectory was associated with a doubling of the likelihood of remission at 5 years. This was achieved without intensive lifestyle interventions or extreme calorie restrictions. Greater attention should be paid to enabling people to achieve weight loss following diagnosis of Type 2 diabetes.

Regression to the Mean Contributes to the Apparent Improvement in Glycemia 3.8 Years After Screening: The ELSA-Brasil Study

“…The regression from diabetes we found after adjusting for RTM (20%) is comparable to that of those enrolled in a trial of community-based screening (Anglo-Danish-Dutch Study of Intensive Treatment In People with Screen Detected Diabetes in Primary Care [ADDITION]-Cambridge study), in which 30% of participants initially detected were below diagnostic cutoffs (HbA 1c ,6.5%; ,43 mol/mol off antidiabetic medication) at the 5-year follow-up (5). Their slightly greater frequency of glycemic regression may be due to the more intensive intervention offered in the treatment arm of the trial.…”

“…In one community-based cohort of individuals detected in a trial for screening and early treatment of diabetes, 30% of the initially detected and confirmed patients presented partial or complete remission from diabetes at 5 years (5). Additionally, in a community-based cohort of individuals with IH (6), remission to normal levels at 1 year was present in 54.0%.…”

The Potential of Black Cumin (Nigella sativa, L.) Seeds Extract to Prevent Polyphagia and Weight Loss in Rattus Norvegicus of Diabetes Mellitus-Type 2

“…Limitations of glucose in cells of DM patients force lipolysis of adipocyte cells, release energy deposits into the circulation and hepatocytes that perform gluconeogenesis [6; 7]. Even though the DM patients are suffering often accompanied by polyphagia, decreased digestive efficiency and increased gluconeogenesis, it causes on the weight loss [8]; hence, the body of DM patients quickly becomes very emaciated, especially in DM-2 of non-obesity.…”

Clinical and cost-effectiveness of a diabetes education and behavioural weight management programme versus a diabetes education programme in adults with a recent diagnosis of type 2 diabetes: study protocol for the Glucose Lowering through Weight management (GLoW) randomised controlled trial

“…We have shown that losing a moderate amount of weight or making healthy behaviour changes (eg, increasing physical activity, reducing alcohol, energy and fat intake) in the first year after diagnosis can reduce the likelihood of stroke or heart attack in the next 5-10 years [10][11][12] and increase the likelihood of achieving remission at 5 years. 13 The Look AHEAD trial demonstrated that intensive specialist-led behavioural programmes could lead to weight loss and reductions in cardiovascular risk factors over 8-year follow-up. 14 However, there are currently insufficient resources in the UK NHS to provide intensive, specialist-led behavioural programmes to 3.2 million individuals who have T2D and the additional 200 000 individuals who are diagnosed each year.…”