The effects of a drastic change in lifestyle on the reversibility of Type 2 Diabetes

The present study examined the effects of a long-term intensive weight-loss intervention (ILI) on type 2 diabetes mellitus (T2DM). ILI was associated with a greater probability of partial remission (fasting blood sugar <126 mg/dl) of diabetes, and a low prevalence of absolute remission (normal blood sugar levels). 

T2DM is a condition characterized by high blood glucose, caused by insulin deficiency and/or insulin resistance (cells fail to respond to the actions of insulin). Excess weight is associated with insulin resistance and may trigger or exacerbate T2DM. However, it is unclear if this effect is reversible through weight reduction.

This study included 4,503 overweight adults with type 2 diabetes. 2241 participants were assigned to the ILI intervention arm, whereas 2263 were allocated to a diabetes support and education intervention (DSE) group.

The ILI included weekly group and individual counseling in the first 6 months, followed by 3 sessions per month for the second 6 months and twice-monthly contact and regular refresher group series and campaigns in years 2 to 4. It aimed to reduce total caloric intake and increase physical activity. DSE consisted of three annual group sessions focusing on diet, physical activity, and social support.

The results show that participants in the ILI group lost significantly more weight and had significantly improved fitness compared to the DSE group. The ILI group was significantly more likely to experience any remission (partial or complete), particularly during the first year (11.5% vs. 2%). Remission was sustained (at least 4 years) in 3.5% of ILI participants compared to less than 2% in the DSE group.

In this study, an intensive weight-loss intervention was not associated with substantial rates of sustained complete remission. However, partial remission is possible, the rates being 3 to 6 times higher than the alternative, less intensive intervention (DSE group). Weight loss and improved fitness may not directly heal diabetes, but certainly improve general well-being and decrease diabetes-related heart and vessel diseases.