Reversing type 2 diabetes can lower your risk of heart and kidney problems

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Reversing type 2 diabetes can lower your risk of heart and chronic kidney disease, according to international research. Type 2 diabetes patients can achieve remission through diet and lifestyle changes, and the researchers investigated how this could impact the health risks that come with diabetes. Using data from a 12-year study on type 2 diabetes lifestyle changes, the researchers compared how well participants achieved remission with how many went on to develop chronic kidney disease or cardiovascular disease. They say any evidence of remission, even if it was short-lived, was associated with a 40% lower risk of cardiovascular disease and a 33% lower rate of chronic kidney disease compared to those who hadn’t achieved remission at all during the study. The researchers say it’s possible the lifestyle changes required to achieve remission could be playing a role in reducing the risk of disease.

Journal/conference: Diabetologia

Link to research (DOI): 10.1007/s00125-023-06048-6

Organisation/s: Royal College of Surgeons of Ireland, Ireland

Funder: The Look AHEAD study was funded by the National Institutes of
Health through cooperative agreements with the National Institute of Diabetes
and Digestive and Kidney Diseases (DK57136, DK57149, DK56990,
DK57177, DK57171, DK57151, DK57182, DK57131, DK57002,
DK57078, DK57154, DK57178, DK57219, DK57008, DK57135 and
DK56992) Additional funding was provided by the National Heart, Lung
and Blood Institute, the National Institute of Nursing Research, the National
Center on Minority Health and Health Disparities, the NIH Office of
Research on Women’s Health and the US Centers for Disease Control and
Prevention. This research was supported in part by the Intramural Research
Program of the National Institute of Diabetes and Digestive and Kidney
Diseases. The Indian Health Service provided personnel, medical oversight
and use of facilities. The opinions expressed in this paper are those
of the authors and do not necessarily reflect the views of the Indian Health
Service or other funding sources. Additional support was received from the
Johns Hopkins Medical Institutions Bayview General Clinical Research
Center (M01RR02719), the Massachusetts General Hospital Mallinckrodt
General Clinical Research Center and the Massachusetts Institute of Technology
General Clinical Research Center (M01RR01066), the Harvard
Clinical and Translational Science Center (RR025758-04), the University
of Colorado Health Sciences Center General Clinical Research Center
(M01RR00051) and Clinical Nutrition Research Unit (P30 DK48520),
the University of Tennessee at Memphis General Clinical Research Center
(M01RR0021140), the University of Pittsburgh General Clinical Research
Center (GCRC) (M01RR000056), the Clinical Translational Research
Center funded by Clinical & Translational Science Award UL1 RR 024153
and NIH grant DK 046204, the VA Puget Sound Health Care System Medical
Research Service, Department of Veterans Affairs and the Frederic C.
Bartter General Clinical Research Center (M01RR01346). The following
organisations have committed to make major contributions to the Look
AHEAD programme: FedEx Corporation, Health Management Resources,
LifeScan Inc. (a Johnson & Johnson Company), OPTIFAST® of Nestle
HealthCare Nutrition Inc., Hoffmann-La Roche Inc., Abbott Nutrition and
the Slim-Fast brand of Unilever North America. Some of the information
contained herein was derived from data provided by the Bureau of Vital Statistics,
New York City Department of Health and Mental Hygiene. EWG is
supported by the Science Foundation Ireland (grant number 22/RP/10091),
the UK National Institute of Health Research and the UK Royal Society.

Media release

From: European Association of the Study of Diabetes

New study is one of first to show people with evidence of any remission of diabetes from weight-loss trial had a 40% lower rate of cardiovascular disease and 33% lower rate of chronic kidney disease

While several trials have shown that substantial weight loss using diet and lifestyle can reverse type 2 diabetes, new research published in Diabetologia (the journal of the European Association of the Study of Diabetes [EASD]) is among the first to show the subsequent impact of remission on cardiovascular outcomes. The study is by Professor Edward Gregg, Head of the School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland, and colleagues.

The new study shows that in patients that took part in the Look AHEAD study, those with any evidence of remission had a 40% lower rate of cardiovascular disease (CVD) and 33% lower rate of chronic kidney disease (CKD).

The Look AHEAD study was a multi-centre RCT that compared the effect of a 12-year intensive lifestyle intervention (ILI) with that of diabetes support and education (DSE) on CVD and other long-term health conditions. The study, carried out between 2001 and 2016, recruited and randomised 5145 adults with overweight or obesity (BMI >25 kg/m2 for non-insulin users or BMI >27 kg/m2 for insulin users) aged 45–76 years with type 2 diabetes. The authors conducted an observational post hoc analysis of participants in both groups, classified them based on remission status, and then compared long-term outcomes (described below) based on any remission, and the duration of remission, over a period of 12 years. They compared the incidence of CVD and CKD among more than 4000 participants, respectively, based on achievement and duration of diabetes remission.

Participants were 58% female, and had a mean age of 59 years, a mean duration of diabetes of 6 years, and a mean BMI of 35.8 kg/m2 (in the range of severe obesity). The authors applied an epidemiological definition of remission: taking no diabetes medications and having a glycated haemoglobin (HbA1c – a measure of blood sugar control) of <48 mmol/mol (6.5%) at a single point in time.

The team defined high-risk or very high-risk CKD based on the Kidney Disease Improving Global Outcomes (KDIGO) criteria, and CVD incidence as any occurrence of non-fatal acute heart attack, stroke, admission for angina or CVD death.

Participants with evidence of any diabetes remission during follow-up had a 33% lower rate of CKD and a 40% lower rate of CVD in analyses adjusting for HbA1c, blood pressure, blood fats, CVD history, diabetes duration and intervention arm, compared to participants without remission. The magnitude of risk reduction was greatest for participants with evidence of longer-term remission.

The authors say they observed three main findings related to the implications of achieving diabetes remission. First, although 18% of participants achieved remission at some point during follow-up, the percentage of participants with current remission had decreased to 3% by the 8th year of the study, underlining the challenges of keeping weight off using lifestyle interventions. Second, despite the relatively short-lived durations of most episodes of remission, they found that any achievement of remission was associated with 33% and 40% lower rates of CKD and CVD, respectively, compared with participants who did not achieve remission, and risk reduction was even greater (55% and 49%, respectively) among those who had evidence of at least 4 years of remission (see table 2 and figure 2 of full paper)  Third, participants with a short duration of diabetes, low starting HbA1c and a large magnitude of weight loss were most likely to experience remission. The authors conclude that the associations they found “may be explained by post-baseline improvements in weight, fitness, HbA1c and LDL (bad) cholesterol.”

Professor Gregg says: “As the first intervention study to associate remission with reduction of diabetes-related complications, this is encouraging news for those who can achieve remission from type 2 diabetes. While our study is also a reminder that maintenance of weight loss and remission is difficult, our findings suggests any success with remission is associated with later health benefits.”

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