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Intensive medical treatment

Intensive medical treatment reverses type 2 diabetes

During the intensive intervention period, weight loss and normoglycemia were targeted using lifestyle approaches and treatment with metformin, acarbose, and insulin glargine

Type 2 diabetes can be reversed with intensive medical treatment using oral medications, insulin and lifestyle therapies, according to a small study published in the Endocrine Society's Journal of Clinical Endocrinology & Metabolism. The study researchers reported that short course of intensive lifestyle and drug therapy achieves on-treatment normoglycemia and promotes sustained weight loss. It may also achieve prolonged, drug-free diabetes remission and strongly supports ongoing studies of novel medical regimens targeting remission.

Dr Natalia McInnes (Credit: McMaster University)

"By using a combination of oral medications, insulin and lifestyle therapies to treat patients intensively for two to four months, we found that up to 40 percent of participants were able to stay in remission three months after stopping diabetes medications," said the study's first author, Dr Natalia McInnes, McMaster University and Hamilton Health Sciences, in Hamilton, Ontario, Canada. "The findings support the notion that type 2 diabetes can be reversed, at least in the short term not only with bariatric surgery, but with medical approaches."

For the study, ‘Piloting a Remission Strategy in Type 2 Diabetes: Results of a Randomized Controlled Trial’, the researchers randomly divided 83 individuals with the condition into three study groups. Two of the groups received an intensive metabolic intervention where they were provided with a personalised exercise plan and a suggested meal plan that reduced their daily calorie intake by 500 to 750 calories a day.

These study participants met regularly with a nurse and dietitian to track their progress and received oral medications and insulin at bedtime to tightly manage their blood glucose levels. One group underwent the intervention for eight weeks, while the other was treated intensively for 16 weeks. After the intervention, individuals in both groups stopped taking diabetes medications and were encouraged to continue with lifestyle changes.

The two intervention groups were compared to a control group of individuals with type 2 diabetes. Participants in this group received standard blood sugar management advice from their usual healthcare provider for the duration of the trial, and they received standard lifestyle advice. Participants in all three groups received usual diabetes care if they experienced a diabetes relapse.

Study participants had their average blood glucose levels from the past two to three months measured using a HbA1C blood test at eight, 20, 28 and 52 weeks to gauge how well their blood sugar was controlled. They also undertook oral glucose tolerance tests.

At eight weeks, 50.0% of the 8-week intervention group versus 3.6% of controls achieved normoglycemia on therapy (RR 14.0, 95% CI 1.97-99.38), and at 16 weeks, these percentages were 70.4% in the 16-week group and 3.6% in controls (RR 19.7, 2.83-137.13). Twelve weeks after completion of the intervention, 21.4% of the 8-week group compared to 10.7% of controls (RR 2.00, 0.55-7.22) and 40.7% of the 16-week group compared to 14.3% of controls (RR 2.85, 1.03-7.87) met HbA1C criteria for complete or partial diabetes remission.

"The research might shift the paradigm of treating diabetes from simply controlling glucose to an approach where we induce remission and then monitor patients for any signs of relapse," McInnes said. "The idea of reversing the disease is very appealing to individuals with diabetes. It motivates them to make significant lifestyle changes and to achieve normal glucose levels with the help of medications. This likely gives pancreas a rest and decreases fat stores in the body, which in turn improves insulin production and effectiveness."

During the intensive intervention period, weight loss and normoglycemia were targeted using lifestyle approaches and treatment with metformin, acarbose, and insulin glargine. Diabetes drugs were then discontinued in the intervention groups and participants were followed for hyperglycaemic relapse.

"We chose to use metformin, acarbose and basal insulin glargine in this trial as these medications have all been shown to slow or prevent the development of type 2 diabetes,” said senior investigator on the trial, Dr Hertzel C Gerstein, McMaster University and Hamilton Health Sciences. “However, other drug combinations could lead to higher remission rates and need to be systematically studied with regard to this outcome." 

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