Weight Loss Shown to be Strongest Predictor of Type 2 Diabetes Remission

A new post-hoc analysis of data from the Diabetes Remission Clinical Trial (DiRECT) showed weight loss was the strongest predictor of type 2 diabetes (T2D) remission.

“Remission should therefore be considered a realistic management target for any individual within 6 years of diagnosis. It can be achieved safely and effectively using evidence-based weight management,” wrote authors in the research article published September 1, 2020 in the journal Diabetes Medicine.

Researchers analyzed findings for 149 participants who were randomly assigned to the weight loss intervention arm of DiRECT, which consisted of a total diet replacement with shakes and soups at 825-853 kcal/day for 3-5 months plus maintenance support for 2 years.

Participants were aged between 20-65 years, with a T2D duration of <6 years and a body mass index (BMI) of 27-45 kg/m2 and were not receiving insulin.

Overall, T2D remission (A1c <6.5% without antidiabetes medications) was achieved by 46% (68/149) of participants at 12 months and by 36% (53/149) at 24 months.

Using logistic regression analyses, researchers found that weight loss was the strongest predictor of T2D remission at 12 months (adjusted odds ratio [aOR] per kg weight loss 1.24, 95% confidence interval [CI] 1.14-1.34; P<.0001) and 24 months (aOR per kg weight loss 1.23, 95% CI 1.13-1.35; P<.001).

Each additional kilogram of weight loss was associated with a respective 24% and 23% higher odds for remission after researchers adjusted for potential confounding factors (eg, BMI). Also, the results showed that measuring weight loss in kilograms or as a percentage were equally good predictors of remission.

Early weight loss and higher program attendance were shown to be positive predictors of goal attainment. The strongest predictor of remission at both 12 and 24 months outside of weight loss, was taking fewer antidiabetes medications at baseline; results showed that each additional medication was associated with an approximate 75% lower chance of achieving the goal.

Baseline BMI, fasting insulin, fasting C-peptide, and T2D duration did not predict remission.

“Other than weight loss, most predictors were modest, and not sufficient to identify subgroups for which remission was not a worthwhile target,” concluded authors. “Although not all people with type 2 diabetes are able to achieve remission, limiting this type of service to those most likely to be successful cannot be done using the criteria examined.”