Intense Lifestyle Change for Diabetes

Type 2 diabetes remission rates higher with intensive lifestyle intervention than with support and education

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) A healthy diet and plenty of exercise are essential for managing type 2 diabetes. Now it looks like nutrition and exercise can even reverse this serious disease.

Patients with type 2 diabetes may have a better chance of partial remission (lessening of symptoms) if they participate in an intensive lifestyle intervention program that involves counseling sessions and goals to reduce calories and boost physical activity, according to a recent study.

Results also showed that diabetes patients in the intensive lifestyle intervention program were more likely to achieve total remission (normal blood sugar without medication) than patients who received diabetes support and education.

Even though patients in the lifestyle intervention group had higher rates of remission, the overall rates of remission were low for both groups.

"Eat healthy and exercise regularly if you have diabetes."

The study was conducted by Edward W. Gregg, PhD, of the Centers for Disease Control and Prevention (CDC), and colleagues.

Diet and exercise are a key part of managing diabetes. Yet it remains unclear whether diet and exercise can reverse diabetes.

"Patients diagnosed as having type 2 diabetes frequently ask their physicians whether their condition is reversible, and some physicians may provide hopeful advice that lifestyle change can normalize [blood sugar] levels," Dr. Gregg and colleagues said in background information to their study.

"However, the rate of remission of type 2 diabetes that may be achieved using non-surgical approaches has not been reported," they said.

The researchers set up a study to see if lifestyle intervention changed the rate of complete or partial remission in patients with type 2 diabetes. They compared remission rates between patients who participated in the intensive lifestyle intervention and those who received diabetes support and education.

The lifestyle intervention involved weekly group and individual counseling for the first 6 months, three sessions per month for the second 6 months and twice-a-month contact and refresher group series and campaigns from the second year through the fourth year. The intervention was designed to lower patients' daily calories to 1,200 to 1,800 calories per day by reducing the amount of saturated and total fat that patients ate and by boosting exercise levels to 175 minutes per week.

The diabetes support and education program included three group sessions per year on diet, physical activity and social support.

Results showed:

  • Lifestyle intervention patients lost more weight than support and education patients after 1 year (8.6 percent loss versus 0.7 percent loss, respectively) and after 4 years (4.7 percent loss versus 0.8 percent loss, respectively).
  • Lifestyle intervention patients had greater increases in fitness than support and education patients after 1 year (20.6 percent boost versus 5.3 percent boost, respectively) and after 4 years (4.9 percent boost versus 1.5 percent loss, respectively).
  • Lifestyle intervention patients were more likely to experience partial or complete remission, with rates of 11.5 percent during the first year and 7.3 percent at year 4, compared with 2 percent of the support and education group at both year 1 and year 4.
  • Overall remission rates were low in both patient groups, with rates of 1.3 percent for lifestyle intervention patients versus 0.1 percent for support and education patients at year 1 and 0.7 percent of lifestyle intervention patients versus 0.2 percent of support and education patients at year 4.
  • Among lifestyle intervention patients, 9.2 percent had sustained remission for at least 2 years, 6.4 percent had sustained remission for at least 3 years and 3.5 percent had sustained remission for at least 4 years. In comparison, among support and education patients, less than 2 percent had sustained remission for at least 2 years, 1.3 percent had sustained remission for at least 3 years and 0.5 percent had sustained remission for at least 4 years.
  • Remission rates were about 15 to 21 percent higher among patients with substantial weight loss or boost in fitness, who have had diabetes for less time or who had lower levels of HbA1c (a measure of blood sugar over time).

"The increasing worldwide prevalence of type 2 diabetes, along with its wide-ranging complications, has led to hopes that the disease can be reversed or prevented," the authors said.

This study, they continued, showed that complete remission is rare after intensive lifestyle intervention.

"However, partial remission, defined as a transition to pre-diabetic or normal [blood sugar] levels without drug treatment for a specific period, is an obtainable goal for some patients with type 2 diabetes," they said.

The results of this study add to a large body of evidence showing that diet and exercise play a large role in the battle against diabetes.

The research included 2,241 patients in the intensive lifestyle intervention group and 2,262 patients in the diabetes support and education group.

The study was published in the December 19 issue of the Journal of the American Medical Association (JAMA). The research was funded by the US Department of Health and Human Services and the National Institute of Diabetes and Digestive and Kidney Diseases among many other organizations. Some of the authors disclosed ties to various pharmaceutical companies, including Pfizer, Eli Lilly, Boeringer Ingelheim and Johnson and Johnson.

Reviewed by: 
Review Date: 
December 18, 2012
Last Updated:
December 19, 2012