An open-label, cluster-randomized trial in the UK showed that intensive weight management achieved remission of type 2 diabetes (T2D). The trial included 306 patients from 49 general practices between July 25, 2014, and Aug 5, 2017. The patients aged 20–65 years who had been diagnosed with T2D within the past 6 years, had a body-mass index of 27–45 kg/m2, and were not receiving insulin. The intervention comprised withdrawal of antidiabetic and antihypertensive drugs, total diet replacement (825–853 kcal/day formula diet consisting of 59% carbohydrates, 13% fat, 26% protein, and 2% fiber for 3–5 months), stepped food reintroduction (comprising of 50% carbs, 35% total fat, and 15% protein for 2–8 weeks), and structured support for long-term weight loss maintenance. Remission of diabetes was defined as glycated hemoglobin of less than 6·5% (<48 mmol/mol) after at least 2 months off all antidiabetic medications, from baseline to 12 months. Diabetes remission was achieved in 68 (46%) participants in the intervention group and six (4%) participants in the control group (odds ratio 19·7). Remission was more prevalent for those with more weight loss, with achievement in none of 76 participants who gained weight, in 7%, 34%, 57% and 86% of participants who maintained 0–5 kg, 5–10 kg, 10–15 kg, and 15 kg or more loss, respectively. Quality of life improved in the intervention group, and decreased in the control group. More serious adverse events were reported in the intervention group (4%) than in the control group (1%). No serious adverse events led to withdrawal from the study. The findings suggest that remission of T2D is practical with non-pharmacological measures and weight loss should be the top priority. Source: http://www.thelancet.com/
