Is type 2 diabetes reversible?

JAMA2012;308:2489-96OpenUrlCrossRefPubMedWeb of Science

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Intensive, prolonged, and repeated efforts to encourage healthier lifestyles can induce remission of type 2 diabetes in some obese adults, say researchers. But complete remission remains rare, and even partial remission tends to be transient. At the end of a trial that lasted four years, 7.3% (95% CI 6.2% to 8.4%) of adults given the intensive intervention and 2% (1.5% to 2.7%) of controls were in complete or partial remission. The intervention worked best during the first year—a third of adults who were in remission at one year relapsed in the next. Participants who lost the most weight, gained the most fitness, and using no insulin at baseline had the best chance of remission⇑.

The trial recruited just over 5000 overweight and obese adults with type 2 diabetes and was designed to look for cardiovascular events and deaths, not remission. These analyses are exploratory, say the authors. But they do suggest that intensive lifestyle measures to reduce weight and increase fitness can help a few obese adults reverse their disease, at least for a while.

This result was disappointing, says a linked editorial (p 2517), but in line with other trials of intensive medical or lifestyle interventions. Bariatric surgery is beginning to look like a better option. Surgery is consistently associated with high rates of remission in large observational studies.