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Category: Type 1 Diabetes

American Diabetes Month: Weight Loss & Diabetes

November marks the beginning of American Diabetes Month, an observance meant to promote awareness of diabetes among individuals, health care professionals, and communities as well as the multi-faceted impact of the condition on millions of Americans. As one of the leading causes of death and disability in the United States, type 2 diabetes affects over 30 million Americans. It has been characterized as a progressive, irreversible condition leading to the development of long-term health complications, including hyperglycemia, hypertension, blindness, and increased cardiovascular risk. However, evidence exists that biochemical remission – or a level of glycemia under the diagnostic threshold – is possible and can be achieved through weight loss.

 Currently, standard care for newly diagnosed type 2 diabetes patients includes structured education, which has had minor effects on weight management and glucose control. Individuals with both obesity and type 2 diabetes can experience remission following weight loss surgery; most previous studies have shown success in reaching remission states as a result of bariatric surgery or intensive low-calorie diets. Prior research has revealed that diabetic patients who followed an intensive low-calorie diet – below 700 calories a day for 8 weeks – were able to achieve remission. However, a recent study aims to prove that type 2 diabetes remission may be possible without extreme dietary intervention, revealing that even

moderate weight loss within the first few years of type 2 diabetes diagnosis can have a significant effect.

 

Weight Loss and Type 2 Diabetes Remission

 Recently published in the journal Diabetic Medicine, a study from the University of Cambridge aims to determine whether diabetes education and behavioral weight management programs can achieve better glucose control and improve health outcomes than education alone. Researchers hoped to determine whether any health improvements found could justify the high costs of implementing these programs.

 A team of investigators from the University of Cambridge attempted to quantify the relationship between lifestyle interventions after type 2 diabetes diagnosis and the likelihood of remission of diabetes at 5-year follow-up. They analyzed data from 867 participants aged between 40 and 69 with newly diagnosed type 2 diabetes, who were part of the ADDITION-Cambridge prospective trial . Participants’ progress was tracked for a total duration of 5 years, during which investigators routinely analyzed medical data to determine the probability of remission.

 By the 5-year mark, the team found 257 individuals, or 30% of the cohort, had achieved remission. Participants who had at least a 10% reduction in weight within 5 years of type 2 diabetes diagnosis were more than twice as likely to experience remission at follow-up compared with individuals who had not lost weight. These findings indicate the significant benefits of weight reduction alone – regardless of the weight lost – and underscore the critical role weight management can play in optimizing health outcomes for type 2 diabetes patients.

Importance of Lifestyle Interventions

 As the models of extreme weight loss programs previously studied are challenging to implement and their results can be difficult to achieve, the latest findings propose a more approachable alternative. Moderate weight loss of 10% of a patient’s initial weight at diagnosis can send diabetes into remission and be more achievable on a larger scale. Senior author Prof. Simon Griffin argues that the study’s results underscore the importance of consistent dietary and lifestyle interventions in managing and potentially reversing diabetes, reinforcing the crucial role of weight management in diabetes care.

Although the team’s results are promising, other research implicates that remission may be difficult to achieve regardless of the amount of weight lost. A larger scale study published earlier this year of over 10,000 individuals with type 2 diabetes found that at the end of the 8-year follow-up period only 4.97% of participants achieved remission.

 Continuing the research efforts, investigators from the University of Cambridge are currently recruiting participants for a forthcoming Glucose Lowering through Weight Management (GLoW) study. The prospective trial funded by the National Institute for Health Research will aim to determine whether tailored diabetes education and behavioral weight management programs would better serve diabetes patients than current education-only programs offered in the United Kingdom.

Achieving remission through moderate dietary intervention – as opposed to extreme dieting or intensive lifestyle interventions – brings promise to the millions of patients struggling with type 2 diabetes. A more manageable approach, aiming for a 10% reduction in weight can help patients improve health outcomes irrespective of whether remission is achieved. The study’s findings highlight the importance of dietary counseling for patients with type 2 diabetes and the potential implications of a revised approach to diabetes care. Future investigation will center around developing optimal techniques for supporting diabetic patients, promoting weight loss efforts, and improving weight management to reduce symptoms of the condition and even achieve states of remission on a larger scale.

Evolution of Diabetes Care in the United States

Over the past decade, advancements in diabetes treatment and care in the United States have been vast, implicating the potential for a significant improvement of population health outcomes. However, many factors can influence the ability of a patient to receive adequate medical care – including accessibility, geographic location, and cost – and oftentimes marginalized demographics experience difficulties with securing effective treatment. While developments in the field may greatly benefit patients with dependable access to care, advances in diabetes treatment can only have a positive impact on public health outcomes if they effectively reach all at-risk populations.

 Recently published in Jama Internal Medicine, a nationally representative investigation by researchers from the Massachusetts General Hospital in Boston evaluated the changes in population-level achievement of diabetes treatment targets in the United States from 2005 to 2016. The study’s findings reveal the real-world implications of advances in care, technology, and awareness – which may not be as significant as expected.

 Evaluation of the Cascade of Diabetes Care

Led by Dr. Pooyan Kazemian, from the Massachusetts General Hospital and Harvard Medical School, a team of researchers set out to evaluate whether U.S. diabetes care – defined as diabetes diagnosis, linkage to care, and achievement of individual and combined treatment targets – improved from 2005 to 2016. Study authors also investigated potential disparities in diabetes care, and whether these have persisted over the years despite increased efforts and resources.

 Researchers analyzed data on 2,488 individuals derived from National Health and Nutrition Examination surveys conducted between 2005 and 2016, including only data from non-pregnant American adults with diabetes above the age of 18. The main outcomes measured were the rates of participants – overall and stratified by age, sex, and race – who were linked to diabetes care and met glycemic, cholesterol level, blood pressure, and smoking abstinence targets, as well as the composite of all targets.

 Further Improvement Needed in Diabetes Care

Out of the studied cohort of nearly 2,500 participants, approximately 1 in 4 adults with diagnosed diabetes achieved the composite goal of all targets. During the period of 2013-2016, 94% of the 1,742 adults diagnosed with diabetes were linked to diabetes care, 64% met hemoglobin A1c levels, 70% met blood pressure levels, and 57% met cholesterol level targets. Overall during this period, only 23% achieved the composite goal. During the periods of 2005-2008 and 2009-2012, rates of achieved composite targets were equally low at 23% and 25%, respectively. Moreover, researchers found no significant improvement in diagnosis or target achievement during the study period as a whole.

 Disparities in care were also reported, with significant gaps in achieving diabetes targets between certain demographics. Compared with middle-aged adults with diagnosed diabetes, older individuals met composite targets at higher rates, while younger adults had lower odds of meeting these goals. Additionally, women in general had lower rates of achieved composite targets than their male counterparts, as did non-Hispanic black individuals compared with non-Hispanic white individuals.

 The strongest predictor of linkage to diabetes care was health insurance, suggesting that cost may be a notable determinant of access to treatment and in turn, of patient ability to meet health targets.  As Dr. Kazemian’s study reveals, the advances in diabetes over the past decade have not led to quantifiable improvement in population-level health outcomes. Gaps in diabetes care that were present in 2005 persist today, particularly among younger adults, women, and non-white patients. These results call for a re-evaluation of the present approach to diabetes treatment and underscore the need for more strategic efforts directed at ameliorating age-old disparities in care.