T2D Remission via Lifestyle Intervention Reduces CVD, CKD Risk: Daily Dose

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Last week, we reported on findings from a post hoc analysis of the Look AHEAD study published in Diabetologia that examined the impact of remission from type 2 diabetes (T2D) on long-term health outcomes.

The study

Investigators analyzed data from 4488 adults (58% women; mean age, 59 years) aged 45 to 76 years with T2D and overweight or obesity who participated in Look AHEAD, the largest and longest randomized controlled study of intensive weight loss conducted to date. The study compared the effects of a 12-year intensive lifestyle intervention (ILI) to diabetes support and education (DSE) on CVD and other long-term outcomes.

Look AHEAD participants attended a baseline clinic visit between August 2001 and April 2004 as well as annual follow-up visits for 4 years, followed by visits every other year up to 12 years. Participants were considered to have T2D remission if they had an HbA1c of <6.5% without the use of glucose-lowering medications at any follow-up visit.

The findings

Among the 4488 individuals, 12.7% achieved T2D remission at year 1. The prevalence of remission among the ILI group was 11.2% at year 1 and declined by about 0.7 percentage points annually until it reached 3.7% at 12 years. Among the DSE group, the prevalence of remission remained at approximately 2% throughout the follow-up.

In multivariable analyses that adjusted for HbA1c, blood pressure, lipid levels, CVD history, diabetes duration, and intervention arm, results showed that participants with any evidence of remission during follow-up had a 33% lower rate of CKD (HR 0.67, 95% CI 0.52-0.87) and a 40% lower rate of CVD (HR 0.60, 95% CI 0.47-0.79) compared to those who did not. The risk reduction was even greater (55% and 49%, respectively) among participants who had evidence of at least 4 years of remission.

Authors' comment

"Achievement of type 2 diabetes remission by effective lifestyle intervention can lead to a large reduction in the incidence of CKD and CVD."

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