Early intensive action puts brakes on type 2 diabetes
medwireNews: A pilot trial demonstrates that a short course of intensive therapy involving both medication and lifestyle interventions can lead to remission of type 2 diabetes in recently diagnosed patients.
“The research might shift the paradigm of treating diabetes from simply controlling glucose to an approach where we induce remission and then monitor patients for any signs of relapse,” said study author Natalia McInnes (McMaster University, Hamilton, Ontario, Canada) in a press statement.
“The idea of reversing the disease is very appealing to individuals with diabetes. It motivates them to make significant lifestyle changes and to achieve normal glucose levels with the help of medications.”
The randomized trial included just 83 participants, divided into three groups, two of which received regular meetings with a dietician and a kinesiologist (including small-group gym sessions), and medication with insulin glargine, metformin, and acarbose, while the third received usual care.
Despite the small study size, the researchers believe its findings suggest that such an approach, “may achieve remission, is acceptable to patients, and may be easily translated into clinical practice.”
Only five of the 132 patients screened refused to participate, and all 83 who were eligible and willing to participate completed their allocated intervention, although two from the control group were subsequently lost to follow-up.
The patients had diabetes that had been diagnosed an average of 14.6 months previously, and around three-quarters were using metformin, achieving an average glycated hemoglobin (HbA1c) level of 6.6%.
Twenty-eight patients received 8 weeks of intensive therapy and 27 received 16 weeks, resulting in on-treatment normoglycemia in 50.0% and 70.4%, respectively. By contrast, just one (3.6%) of 28 patients receiving standard treatment achieved normoglycemia.
Four weeks after completing the intervention, 35.7% of the 8-week group and 44.4% of the 16-week group had HbA1c levels below 6.5% without use of diabetes drugs – the researchers’ definition of partial or complete remission of diabetes. At week 52, 25.0% of the 8-week group and 22.2% of the 16-week group maintained this, compared with 10.7% of the control group.
This “challenges the notion that type 2 diabetes is a permanent and progressive disease,” say the researchers in The Journal of Clinical Endocrinology & Metabolism.
By Eleanor McDermid
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