Diabetes Remission Reduces Risk of Kidney and Heart Disease
By April Hopcroft
A new analysis showed that people with type 2 diabetes who achieved remission through intensive lifestyle intervention had lower rates of kidney disease and heart disease, compared to those who did not reach remission.
In the world of clinical trial research, an early end to a trial can mean one of two things: the intervention was either more or less effective than expected.
One example was the Look AHEAD trial, which was stopped early because the lifestyle interventions “failed” to show reductions in cardiovascular events among people with type 2 diabetes.
While these results were initially viewed as a disappointment by some in the diabetes community, a new analysis suggests a more promising story.
What was the Look AHEAD study?
Look AHEAD studied the impacts of intensive lifestyle changes on weight loss and heart health in over 5,000 people with type 2 diabetes. A recent analysis revealed that participants who achieved diabetes remission saw reductions of over 30% in rates of heart and kidney disease, compared to those who did not reach remission.
The study compared the effect of an intensive lifestyle intervention to that of diabetes support and education on cardiovascular disease and other health conditions. The study included 5,145 adults with type 2 diabetes and overweight or obesity. Participants had an average age of 59 years, diabetes duration of six years, and a BMI of nearly 36. About 60% were female.
While the lifestyle intervention led to greater weight loss and improvements in A1C compared to the control group, there was no difference in the rate of cardiovascular events between the two groups. Since the intervention did not show any cardiovascular benefit, the trial was stopped early, at about 10 years of follow-up.
What did the latest findings show?
In this recent analysis, diabetes remission was defined as having an A1C less than 6.5% and taking no diabetes medications at a single moment in time. About 13% of participants met the definition for remission. These participants had a 33% lower rate of chronic kidney disease (CKD) and a 40% lower rate of heart disease.
“As the first intervention study to associate remission with reduction of diabetes-related complications, this is encouraging news for those who can achieve remission from type 2 diabetes,” said Dr. Edward Gregg, head of the School of Population Health at RCSI University of Medicine and Health Sciences in Ireland.
The longer participants spent in remission, the greater these benefits were for heart and kidney health. Specifically, participants who spent at least four years in remission had a 55% lower risk of CKD and a 49% lower risk of heart disease.
Other key findings included the following:
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Participants were more likely to reach remission if they had a shorter duration of diabetes, lower starting A1C, and a larger amount of weight loss.
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The percentage of participants in remission declined substantially to just 3% by the eighth year of the trial. This highlights just how difficult it is to keep weight off through lifestyle interventions.
With newer medications available for weight management – namely, incretin therapies – it’s possible that sustaining weight loss and diabetes remission could be easier in the future.
The bottom line
These findings shed new light on the Look AHEAD trial, as they suggest that any amount of remission attained by people with type 2 diabetes can lead to long-term benefits for heart and kidney health.
Although the analysis highlights the difficulty of maintaining remission over time, it also points to encouraging outcomes for macrovascular and microvascular complications for those who can reach remission.
Other studies, like the DiRECT trial, have also suggested that remission is linked to a reduction in complications and serious events, including cancer and strokes. In addition to intensive lifestyle intervention and behavioral changes, other approaches to remission focus on low-carb and very low-carb diets.
Diabetes remission may not be the right goal for everyone, but it’s worth talking to your healthcare provider about the different ways to attain it and the benefits to your long-term health.
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