Weight loss in the first 2 years of being diagnosed with type 2 diabetes increases likelihood of diabetes remission

Diabetes, Obesity Metabolism (DOM) NOW – December 2023

Recent interest on very low calorie diet and bariatric surgery for the treatment of overweight/obese patients with type 2 diabetes have provoked interest to achieve diabetes remission as a treatment target. In addition, overweight and obese patients are often encouraged to lose weight to improve their diabetes outcomes. A study from Korea, which was published in Diabetes, Obesity & Metabolism,¹ however, have highlighted the important of early weight loss to enhance the likelihood of inducing diabetes remission.

The study was a retrospective real-world outcomes study derived from database of the Korean National Health Insurance Service. It examined the weight and health outcomes of 114 874 people in Korea who were diagnosed with type 2 diabetes between 2009 and 2012. Participants were then followed up until 2017. More than 23 000 of the participants lost more than 5% of their body weight. 2429 (2.1%) of the participants achieved remission during the trial, defined as fasting blood glucose less than 126 mg/dL (7 mmol/L) at two or more consecutive health examinations after stopping medication. The adjusted odds ratio for remission in the weight loss group was 2.56 (95% confidence interval 2.35–2.79) compared with the group with stable body weight. The greater weight loss the higher the likelihood of remission indicating that diabetes remission was driven primarily by weight loss. The effects of weight loss on remission were significantly greater in subgroups of age <65 years, male sex and body mass index >25. Weight loss within the first 2 years of treating type 2 diabetes mellitus was associated with diabetes remission. This study, therefore, highlights the importance of aggressive weight management from the outset of diabetes diagnosis to increase the likelihood of diabetes remission. I would suggest that such aggressive management to induce significant weight loss is not dissimilar to the early intensive management of hyperglycaemia due to the well-recognized ‘legacy effect of hyperglycaemia’.