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Fighting diabetes

Intensive lifestyle intervention struggles to resolve diabetes

Participants were intended to stick to a 1,200-1,800 calorie/day diet, including the use of liquid meal replacements.
Restricted diet and counselling did not lead to significant levels of absolute T2DM remission

Four-year results from the Look AHEAD trial have shown that even intensive lifestyle intervention has only modest and temporary success in combating type 2 diabetes in overweight and obese individuals, with only 11.5% of diabetic individuals experiencing either a partial or complete remission of their symptoms at 12 months, dropping to 7.3% at four years.

The results of the trial, published in the Journal of the American Medical Association, found that the incidence of absolute remission of diabetes was very low: 1.3% at one year of intervention, and 0.8% at four years.

The authors write, “these analyses of more than 4,500 overweight adults with type 2 diabetes confirm that complete remission associated with an intensive life-style intervention, when defined by glucose normalization without need for drugs, is rare. However, partial remission, defined as a transition to prediabetic or normal glucose levels without drug treatment for a specific period, is an obtainable goal for some patients with type 2 diabetes.”

In comparison,a surgical intervention trial found that 42% of patients who underwent a gastric bypass and 37% of patients who underwent a sleeve gastrectomy had complete remission of their diabetic symptoms at one year.

The new trial was designed to compare the effectiveness of intensive lifestyle intervention in a cohort of 2,241 with 2,262 individuals who underwent a less rigorous programme of diabetic support and education control. The lifestyle intervention consisted of weekly group and individual counselling sessions for the first six months, three sessions per month for the second six months, and fortnightly contact sessions for the remaining four years.

The researchers aimed to restrict the participants’ diet to 1,200 to 1,800 calories a day, and increase their physical activity levels to 175 minutes a week.

The intervention did have significant health benefits: participants lost 8.6% of their weight at year 1 and 4.7% at year 4. The intensive intervention group were more likely to experience any remission of type 2 diabetes than the support and education group: 9.2% experience at least a two-year remission at some point during the study, compared to 1.7% for the support group.

In an accompanying editorial, David Arterburn and Patrick O’Connor say that research, education, and policy efforts should be focused towards prevention, rather than treatment, especially among those with a family history of obesity and diabetes.

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