Type 2 Diabetes Remission: A New Mission in Diabetes Care
What are the key points in the management of type 2 diabetes and how to achieve remission?
Type 2 diabetes is a major global problem that affects both individuals and health care systems. The traditional approach to managing T2DM has been through education and medication. However, this approach doesn't always work, with many patients not achieving adequate control of their blood sugar levels.
T2DM is closely linked to obesity and excessive fat in the liver and pancreas. Therefore, managing weight is becoming more important in treating T2DM. There's evidence that losing weight can lead to T2DM remission, or the disease going away. However, without specific intervention, remission is rare.
Without specific intervention, T2DM remission is infrequent. A U.S. study of 122,781 adults reported a 7-year cumulative incidence of remission as 1.60%, but it was higher (4.6%) in those with early T2DM (<2 years from diagnosis). Data from England, including 2,297,700 people with T2DM, showed that only 1.7% met the criteria for T2DM remission. Those with a T2DM diagnosis of <1 year had greater odds of remission (2.87) than those with a diagnosis of 3–5 years. BMI reduction of ≥10% garnered a 3.57 odds of remission compared with that at <5% reduction.

Metabolic/bariatric surgery (MBS) can lead to significant weight loss and T2DM remission, but it isn't always available or accepted. Increasingly, the focus is shifting towards intensive lifestyle interventions (ILI) to achieve weight loss and T2DM remission.

Recent studies like Look AHEAD (Action for Health in Diabetes), DiRECT (The U.K. Diabetes Remission Clinical Trial), and DIADEM-I (The Diabetes Intervention Accentuating Diet and Enhancing Metabolism) focus on intensive lifestyle interventions (ILI) for weight loss and T2DM remission. Look AHEAD showed significant weight loss in the ILI group compared to the control (−7.9% at 1 year, −3.9% at 4 years). DiRECT achieved 10% weight loss, with 46% achieving remission at 1 year. DIADEM-I, focusing on the Middle East and North Africa, resulted in ∼12% weight loss, with 61% achieving remission at 1 year. DiRECT-Aus, a nonrandomized study in Australia, achieved 11.2% weight loss, with 55% achieving remission at 1 year, though some weight regain occurred. Studies demonstrate the link between weight loss and remission. DiRECT also showed pancreatic recovery via MRI. Another trial, STANDby, reported 43% T2DM remission in South Asians at 4 months, further supporting ILI efficacy.

The recent consensus for T2DM remission is an HbA1c <6.5% for at least 3 months off medications. Newer diabetes and weight loss medications that target the glucagon-like peptide 1 (GLP-1) receptor, GLP-1/glucose-dependent insulinotropic polypeptide receptors (dual agonists), and GLP-1/glucose-dependent insulinotropic polypeptide/glucagon receptors (triagonists), as well as combination therapy targeting GLP-1 and amylin receptors, are promising in achieving significant weight loss and HbA1c levels within the T2DM remission range.

The DiRECT-Aus study (nonrandomized open-label primary care study from Australia that used an intervention similar to those of DiRECT and DIADEM-I) supports T2DM remission through total diet replacement. Early T2DM patients achieving ≥10% weight loss are likely to attain remission, associated with mortality risk reduction. Long-term remission diminishes, but it delays complications. Linking remission to screening aids early intervention and β-cell recovery. While glucocentric, comprehensive care remains crucial.
Future efforts should enhance lifestyle interventions with frequent follow-up, digital support, physical activity, and, if needed, weight loss medications. Embracing T2DM remission as a therapeutic goal is vital.
According to the materials from Diabetes Care "Type 2 Diabetes Remission: A New Mission in Diabetes Care"