medwireNews: A post-hoc analysis of the German Prediabetes Lifestyle Intervention Study (PLIS) has found that people who achieve remission of prediabetes by losing weight through lifestyle intervention for 12 months may in turn reduce their risk for developing type 2 diabetes.
Among 298 people with prediabetes who lost at least 5% bodyweight following a lifestyle intervention for 12 months, 43% returned to normal glucose regulation (NGR), defined as fasting plasma glucose levels below 5.6 mmol/L, glucose tolerance below 7.8 mmol/L, and a glycated hemoglobin level below 39.0 mmol/mol (<5.7%).
These individuals were 73% less likely to develop type 2 diabetes 2 years later than the 57% of individuals who lost 5% bodyweight but still had prediabetes, report Andreas Birkenfeld, from Eberhard-Karls University of Tübingen, Germany, and colleagues in The Lancet Diabetes & Endocrinology.
The PLIS participants were aged 18–75 years and had a BMI of up to 45 kg/m2 and impaired fasting glucose or glucose tolerance prior to intervention.
The interventions included standard US Diabetes Prevention Program (DPP)-based intervention, comprising eight one-to-one advice sessions for a year with 3 hours of exercise per week recommended, intensified lifestyle intervention, encompassing 16 coaching sessions over a year with 6 hours of exercise per week recommended, or control intervention.
The 128 individuals who achieved 5% weight loss and prediabetes remission tended to be younger than their 170 counterparts who remained prediabetic, at 55.6 versus 60.4 years old, which “highlights the importance of early detection and treatment of prediabetes,” say Birkenfeld et al.
The groups with and without remission had similar mean reductions in BMI after 12 months of 3.4 kg/m2 and 2.9 kg/m2, respectively, from baseline values of 32.4 kg/m2 and 32.1 kg/m2. But there was a significant difference in the waist-to-hip ratio, which decreased from a mean 0.93 to 0.90 among participants who achieved prediabetes remission, compared with 0.94 to 0.92 among those who did not.
After achieving a 5% reduction in bodyweight, individuals who met threshold waist circumference reductions of at least 4.5 cm for women and at least 7.4 cm for men were 2.63 times more likely to achieve prediabetes remission than those who did not.
The researchers found a significantly greater decrease in visceral adipose tissue among individuals who achieved prediabetes remission, from a mean 6.2 to 4.1 L versus a reduction from 5.7 to 4.5 L in those who did not achieve remission.
Oral glucose insulin sensitivity also improved significantly more among individuals with prediabetes remission than those without, increasing from 291 to 378 mL/min per m2 versus 278 to 323 mL/min per m2, while there was no significant change in insulin secretion in either group.
The team notes that the proportion or people who achieved remission increased with more visceral fat loss and decreasing weight.
The findings were validated in an analysis of 683 participants with prediabetes from the US DPP study who were randomly assigned to either the lifestyle intervention or control arms of the study for 12 months and lost 5% bodyweight.
The authors comment that reduced visceral adipose tissue and improved insulin sensitivity as mechanisms of prediabetes remission “differ substantially” from those seen in remission of type 2 diabetes, which they say is “driven by an improvement in insulin secretion,” and a predominance of beta-cell secretory capacity.
Given the reduced risk for type 2 diabetes associated with prediabetes remission, “we propose the concept of remission of prediabetes to NGR in analogy to remission of type 2 diabetes and to consider this remission to be a primary aim of care for people with prediabetes,” Birkenfeld et al conclude.
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