10% редукция на теглото увеличава вероятността за ремисия на ЗДТ2

  • October 13, 2019
  • A relatively modest amount of weight loss within the first year of being diagnosed with type 2 diabetes more than doubles the likelihood that patients will be in remission at 5 years, compared with those whose weight remains stable or who gain weight, a new prospective cohort study from the UK indicates.

    “Existing evidence for achieving remission suggests extreme levels of exercise and restrictive diets” are required, lead author Hajira Dambha-Miller, MRCGP, PhD, clinical lecturer in general practice, University of Cambridge, UK, told Medscape Medical News.

    But in this study, “All our participants did different things and [some] still managed to lose weight and achieve remission, so the key message here is that modest amounts of weight change without any extreme dieting or physical activity can result in remission,” she stressed.

    “I am a general practitioner and treat patients with type 2 diabetes on a regular basis,” and intensive lifestyle interventions with extreme diets are “simply not realistic or achievable for my patients, especially in the longer-term,” she said in an e-mail.

    Indeed, the researchers found that 10% weight loss was enough to induce remission in many cases, Dambha-Miller and colleagues explain in their article, published online in Diabetic Medicine.

    “There could be a window of opportunity following diagnosis when people might be more receptive to interventions concerning weight loss. Greater attention should be paid to enabling people to achieve weight loss following diagnosis of type 2 diabetes,” they stress.

    Prior Studies of Extreme Calorie Restriction

    A number of prior studies have shown that type 2 diabetes can be reversed using extremely low calorie diets of under 1000 calories/day for up to a few months.

    For example, in the Diabetes Remission Clinical Trial (DiRECT), liquid meal replacement of 850 calories/day for 3 to 5 months, followed by food reintroduction for 2 to 8 weeks and structured support for long-term weight loss maintenance, led to remission of type 2 diabetes in 36% of patients in the intervention arm at 2 years compared with just 3% of those in the control arm (P < .0001).

    “Other studies with similar intensive interventions in highly selected populations include the Counterbalance trial and Look AHEAD trial,” note Dambha-Miller and colleagues.

    “Whilst our observational findings are consistent with these trials, the specific amount of weight loss required to achieve remission varies. Most previous studies advocate significant weight loss (> 15%), with the DiRECT, Counterbalance, and Look AHEAD trials reporting between 5- and 20-kg weight loss in order to achieve diabetes remission,” they note.

    “Our results suggest that more modest weight loss of > 10% is associated with a higher likelihood of remission if this occurs early in the disease trajectory,” they emphasize.

    A Window of Opportunity in the Few Years After Diagnosis.

    For their study, Dambha-Miller and colleagues took participants from the ADDITION-Cambridge population-based study: 867 participants aged 40-69 years with newly diagnosed type 2 diabetes. The mean age of those included in the analysis was 61 years, 61% were men, and 97% were white.