Achieving Diabetes Remission, For No Matter How Long, Can Lower Kidney, Cardiovascular Risk

Edward Gregg, PhD
Credit: Imperial College London

Evidence of any remission of diabetes from weight loss could confer significant reductions in chronic kidney disease (CKD) and cardiovascular disease among people with type 2 diabetes, according to new findings from the Look AHEAD study.

Analysis of the landmark study, which followed 5000 patients with type 2 diabetes for more than a decade, revealed achieving remission was associated with reductions of more than 30% in rates of both CKD and cardiovascular disease relative to not achieving remission, with additional analysis demonstrating greater benefit with more time spent in remission.¹

“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 Edward Gregg, PhD, head of the School of Population Health, RCSI University of Medicine and Health Sciences.² “While our study is also a reminder that maintenance of weight loss and remission is difficult, our findings suggests any success with remission is associated with later health benefits.”

Launched by the National Institutes of Health in June 2021, the Look AHEAD trial was a multicenter, randomized clinical trial conducted in 16 sites across the US created to develop a greater understanding of the long-term effects of intensive lifestyle intervention compared with disease support and education in individuals with type 2 diabetes who were also overweight or obese. The trial concluded there were no significant differences in cardiovascular outcomes among patients based on treatment arm. Since initial publishing the trial has become a source for a multitude of analyses and other studies examining data from the 12-year trial.³

Led by Gregg and a team of investigators, sought to estimates the association between attain of diabetes remission with subsequent incidence of CKD and cardiovascular disease. Among the 5145 adult patients aged 45-76 years who underwent randomization in the original study, 4488 were identified for inclusion in the investigators’ analytical sample.¹

Investigators pointed out individuals were excluded from the sample if they had already met the definition for remission at baseline, had inadequate follow-up data, or had undergone bariatric surgery during the course of the study.¹

Among the 4488 individuals included in the analytical sample, 12.7% met the definition for remission for at least 1 follow-up visit. Among the intensive lifestyle intervention group, the prevalence of remission was 11.2% at year 1 and declined about 0.7 percentage points every year. In contrast, the prevalence of remission in the support and education group was approximately 2% at year 1 and remained in this range through the duration of the trial. At year 12, the prevalence of remission was 3.7% in the intensive lifestyle group compared to 1.95% in the support and education group.¹

In an analysis adjusted for HbA1c, blood pressure, lipid levels, cardiovascular disease history, diabetes duration, and intervention arm, results pointed to a 33% lower rate of CKD (Hazard Ratio [HR], 0.67; 95% Confidence Interval [CI], 0.52-0.87) and a 40% lower rate of cardiovascular disease (HR, 0.60; 95% CI, 0.47-0.79) among those with any evidence of remission relative to their counterparts without remission. Further analysis underlined the apparent benefits of achieving remission on these outcomes, with those in remission for at least 4 visits achieving a greater magnitude of risk reduction for CKD (HR, 0.45; 95% CI, 0.25-0.82) and cardiovascular disease (HR, 0.51; 95% CI, 0.30-0.89) relative to those without remission.¹

Investigators called attention to multiple limitations within their study to consider. These included, but were not limited to, lack not data to replicate new recommended definitions of remission, inability to determine the onset of diabetes remission with precision, and a lack of randomized design.¹

References:

1. Gregg EW, Chen H, Bancks MP, et al. Impact of remission from type 2 diabetes on long‑term health outcomes: findings from the Look AHEAD study. Diabetologia. Published online January 18, 2024. doi: 10.1007/s00125-023-06048-6
2. New study is one of first to show people with evidence of any remission of diabetes from weight-loss trial had a 40% lower rate of cardiovascular disease and 33% lower rate of chronic kidney disease. EurekAlert! January 18, 2024. Accessed January 18, 2024. https://www.eurekalert.org/news-releases/1031531.
3. Long-term Lifestyle Change for Type 2 Diabetes & Obesity Study: Look AHEAD. National Institute of Diabetes and Digestive and Kidney Diseases. Accessed January 18, 2024. https://www.niddk.nih.gov/about-niddk/research-areas/obesity/long-term-lifestyle-change-type-2-diabetes-obesity-study.