Wednesday, December 19, 2012

Type 2 Diabetes Remission is Real

Bonnie and Steve: One in nine people with diabetes saw their blood sugar levels dip back to a normal or pre-diabetes level after a year on an intensive diet and exercise program, according to a new study from today's Journal of the American Medical Association. Complete remission of type 2 diabetes is still very rare, but the new study can give people with the disease hope that through lifestyle changes, they could end up getting off medication and likely lowering their risk of diabetes-related complications.

The long-term assumption is that once you have diabetes, there's no remission or cure. We have never prescribed to that assumption. This is a great reminder that adopting a healthy diet, physically-active lifestyle and reducing and maintaining a healthy weight can reverse a diabetic state.

People randomly were assigned to an intensive program and diet and exercise counseling with a goal of cutting eating and drinking back to 1200 to 1800 calories per day and increasing physical activity to just under three hours per week. After one year, 11.5 percent of them had at least partial diabetes remission, meaning that without medication their blood sugar levels were no longer above the diabetes threshold. That compared to just two percent of participants in the non-intervention group.

In a separate study from the December 10th issue of Archives of Internal Medicine, two different lifestyle interventions produced significant weight loss among overweight or obese adults in a primary care setting.

The trial design was a 3-group, randomized study that compared both a coach-led, in-person weekly group intervention and a self-directed DVD intervention with usual care. The interventions were adapted from those used in a landmark DPP trial in the 1990's, which produced a 58% reduction in the development of type 2 diabetes over the course of 3 years via modest weight loss.

The maximum weight loss achieved within the coach-led intervention was substantial, and similar in magnitude to that achieved by the DPP lifestyle intervention. Weight loss in the self-directed intervention was less pronounced, but noteworthy given its low resource requirements and high potential for dissemination. Statistically significant improvements in waist circumference and fasting plasma glucose were also seen with both interventions.

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