Diabetes remission provides lasting cardiorenal benefits

New findings from the landmark Look AHEAD study have revealed that achieving remission from type 2 diabetes through weight loss is associated with large reductions in rates of both chronic kidney disease (CKD) and cardiovascular disease (CVD).

Increasingly, remission from type 2 diabetes is being seen as a goal that many people can attain. While previously associated with bariatric surgery, the Look AHEAD and DiRECT studies demonstrated that lifestyle interventions can also be effective in achieving remission from diabetes and prediabetes. The impact of remission through such interventions on long-term health outcomes, however, has not been examined. 

Look AHEAD was a 12-year, multicentre, randomised control trial that compared the effects of an intensive lifestyle intervention with that of diabetes support and education. Researchers conducted observational post hoc analyses of the study data to establish whether achieving remission resulted in a reduction in the incidence of diabetes-related CKD and CVD.

The analytical sample size was 4488 (58% female; mean age, 59 years; mean diabetes duration, 6 years; and mean BMI, 35.8 kg/m²). Diabetes remission (defined as taking no diabetes medication and an HbA_1c <48 mmol/mol) was recorded during at least one follow-up visit in 12.7% of participants. Most remissions were relatively short-lived, with the percentage of participants with remission decreasing to 4% by the eighth year of the study.

Those with any evidence of remission 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]) in adjusted analyses, compared to those without remission. The magnitude of the risk reduction was greatest for those with evidence of longer-term remission.

The authors conclude that these associations may be affected by post-baseline improvements in weight, fitness, HbA_1c and LDL-cholesterol. While this study demonstrates the promise of lifestyle-based remission, they caution that the long-term sustainability of such intensive interventions is unclear and emphasise the need for continued follow-up in remission studies.

The full study findings can be read here.