Intensive lifestyle changes including diet and exercise were significantly more effective than standard counseling and medications for reversing type 2 diabetes, an ongoing federal study shows. But the success rate may add fuel to the debate for those advocating surgery as a more effective method of reversing the disease.
Funded by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), the Look AHEAD: Action for Health in Diabetes study began in 2001 and continues today, but is no longer recruiting participants. The researchers led by Edward Gregg, acting director, Division of Heart Disease and Stroke Prevention,
National Center for Chronic Disease Prevention and Health Promotion, at the CDC aimed to determine whether lifestyle changes can reverse type 2 diabetes and whether the effects are sustained over time.
The 4,503 participants were 45 to 75 years old with an average age of 59 years. They had a median of five years since being diagnosed with diabetes, meaning half had been diagnosed more than five years prior to starting the trial and half had been diagnosed less than five years before. All had body mass index (BMI) scores that placed them in the obese category. Partial remission of diabetes was defined as meeting the criteria for prediabetes and complete remission was defined as having a nondiabetic blood sugar levels or a fasting blood sugar level of less than 126 mg/dL and HbA1c of less than 6.5 percent without medication.
The interim results, reported in the Dec. 19 Journal of the American Medical Association, showed that 11.5 percent of the 2,241 people in the intensive lifestyle group achieved a partial reversal of their diabetes after one year, compared to 7.3 percent of 2,262 in the standard treatment group. Complete reversal of the disease occurred much less often, with only 1.3 percent of the intensive lifestyle group achieving a complete remission after one year and 0.7 percent after four years.
The differences between the two groups were sustained over four years, although the percentage of participants who achieved partial remission of type 2 diabetes declined each year with only 7.3 percent of the lifestyle group meeting the goal after four years.
In an editorial in the same issue Dr. David E. Arterburn of Group Health Research Institute, Seattle, and Dr. Patrick J. O’Connor of HealthPartners Institute for Education and Research in Minneapolis, pointed out that the partial reversal of the disease failed to translate into fewer heart attacks and strokes.
They noted that while other lifestyle trials have shown similarly disappointing results, the evidence is growing that weight-loss surgery may be more effective than either lifestyle treatments or medicines for reversing type 2 diabetes.