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NEW YORK, Jan. 23 (UPI) -- People newly diagnosed with type 2 diabetes can manage blood glucose levels without medication if they shed pounds and maintain that weight loss. Yet, few patients stay in remission through weight loss alone over the long term, a new study indicates. Researchers led by Dr. Andrea Luk, a professor at the Chinese University of Hong Kong and the study's corresponding author, reported these findings Tuesday in the open access journal PLOS Medicine.
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"Previous clinical trials demonstrated that type 2 diabetes remission is possible following sustained weight loss. However, whether these findings could be replicated in a less-controlled, real-world environment ... remained unclear," the study's first author, Hongjiang Wu, an epidemiologist and research assistant professor at the Chinese University of Hong Kong, told UPI via email.
"This knowledge gap motivated this study. Achieving diabetes remission is important because it can significantly reduce diabetes-related complications, reduce the burden of taking medication and lower the risk of potential side effects."
The researchers studied 37,326 people in Hong Kong who were newly diagnosed with type 2 diabetes to assess whether -- and low long -- individuals could control the illness through weight loss.
"Greater weight loss within the first year of diabetes diagnosis was associated with an increased likelihood of achieving diabetes remission," Luk said in a news release.
"However, the incidence of diabetes remission was low, with only 6% of people achieving remission over eight years, and half of those with initial remission returned to hyperglycemia (high blood sugar) within three years, indicating poor sustainability of diabetes remission in real-world setting."
These rates are much lower than in clinical trials, where remission occurred in as many as 73% of patients at one year after their diagnosis.
The study reveals that controlling type 2 diabetes through sustained weight loss is possible in real-world settings, but that few patients will succeed by only managing their weight, particularly over the long-term.
"One reason for the discrepancy with clinical trials is that trial participants receive intensive lifestyle interventions, including holistic support for dietary changes, physical exercise and mental health," according to a news release.
"The researchers conclude that patients should receive early weight management interventions as a way to increase the odds that they will achieve sustained remission."
Dr. Peminda Cabandugama, director of digital obesity at Cleveland Clinic, who was not involved in the research, told UPI via email that "it is encouraging to see more regions of the world doing studies that concern weight management and its related comorbidities.
"The obesity pandemic is generally thought to be a more Western issue, but there are multiple epidemiological studies now showing that it is more of a global problem than ever before."
Cabandugama added that "hopefully, there will be more robust studies coming out globally, such as this one. This would help provide more evidence to global health authorities to develop comprehensive guidelines on the importance of early and chronic intervention of weight management."
A strength of this research is the large number of people in a "real-life" study that includes all the complex variables involved in glucose control in diabetes. These variables include genetic, behavioral, environmental, and cultural factors, Lawrence Mandarino, a professor of medicine at the University of Arizona College of Medicine-Tucson, told UPI via email.
Meanwhile, the study's weakness stems from it being observational and lacking the rigor of a controlled clinical trial, said Mandarino, who also is director of the Center for Disparities in Diabetes, Obesity and Metabolism at the college of medicine.
In his opinion, "remission" also may not be the best term to describe what occurs when a person with type 2 diabetes achieves normal glucose levels. He favors calling this "reversal of high blood glucose."
Reversing to "a healthy level is definitely possible early on in the disease by intensive lifestyle changes, including increased physical activity and reduced caloric consumption," Mandarino said.
The Diabetes Remission Clinical Trial, conducted in primary care practices in the United Kingdom, found high rates of type 2 diabetes remission among people who lost a significant amount of weight -- an average of more than about 22 pounds -- and maintained that drop in weight over 12 to 24 months, according to the U.S. National Institute of Diabetes and Digestive and Kidney Diseases.
Such significant weight loss can be achieved by bariatric surgery or intensive health care professional-guided dietary and lifestyle interventions, Jennifer Nasser, a registered dietitian and associate professor of nutrition science at College of Nursing and Health Professions at Drexel University in Philadelphia, told UPI via email.
Obtaining a referral to a diabetes or weight loss center of excellence to assist with this goal may be an optimal strategy, Nasser said.
"Physicians and registered dietitians with expertise in managing diabetes and weight loss provide the best chance for achieving weight loss significant enough to promote diabetes remission," she said.
Acting soon after being diagnosed with type 2 diabetes is paramount because it's a progressive disease, Dr. Neda Rasouli, a professor of medicine and pharmacy at the University of Colorado School of Medicine in Aurora, Colo., told UPI via email.
Living with type 2 diabetes longer than 10 years and using multiple glucose-lowering medications, including insulin, render weight loss less effective in achieving remission, said Rasouli, who also is associate division head of endocrinology, metabolism and diabetes.
"The key factor is effective interventions at the right time," she said. "So, diabetes remission is possible, but it is important to strike early and strike strong."
