Weight loss strongest predictor of remission in DiRECT
medwireNews: The strongest predictor of type 2 diabetes remission is weight loss, with other variables only modestly associated with outcome and insufficient to identify people unsuitable for attempting this goal, shows a post-hoc analysis of DiRECT data.
“Remission should therefore be considered a realistic management target for any individual within 6 years of diagnosis [which] can be achieved safely and effectively using evidence-based weight management,” write Michael Lean (University of Glasgow, UK) and co-authors in Diabetic Medicine.
The team analyzed findings for 149 participants who were randomly assigned to the weight loss intervention arm of DiRECT, which involved a total diet replacement with shakes and soups at 825–853 kcal/day for 3–5 months plus maintenance support for 2 years. At 12 and 24 months, 46% and 36% of patients, respectively, achieved type 2 diabetes remission (HbA1c <6.5% [<48 mmol/mol], without antidiabetes medication).
Using logistic regression analyses, the team found that weight loss was the strongest predictor of remission at both 12 and 24 months, with each additional kilogram of weight loss associated with a respective 24% and 23% higher odds for remission after adjustment for potential confounders such as baseline BMI.
Furthermore, the data indicate that measuring weight loss in kilograms or as a percentage were equally good predictors of remission, and that early weight loss during the first 4 weeks and higher program attendance were positive predictors of goal attainment.
Aside from weight loss, being prescribed fewer antidiabetes medications at baseline was the strongest predictor at 12 and 24 months, with each additional medication associated with an approximate 75% lower chance of achieving remission.
Higher baseline levels of glycated hemoglobin were significantly associated with lower remission rates at 12 but not 24 months, while having anxiety or being prescribed antidepressants were significantly associated with lower remission rates at both timepoints. The researchers note, however, that the association with anxiety and depression was mediated by lower weight loss among these patients.
The degree of weight loss also mediated the effect of gender on remission; in this case, men were significantly more likely to be in remission at 24 months than women, largely due to the greater weight loss they achieved as a result of a larger calorie deficit during the intervention, Lean et al report.
Other predictors of remission at either timepoint included older age, better quality of life, and lower triglyceride and gamma-glutamyl transferase levels, whereas there was no significant association with BMI, fasting insulin, fasting C‐peptide, or diabetes duration.
Lean and co-authors conclude that none of the predictors they measured were “sufficient to identify people for whom remission is not a worthwhile target.”
They say: “Although not all people with type 2 diabetes are able to achieve remission, limiting this type of service to those most likely to be successful cannot be done using the criteria examined.”
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