Greater weight loss associated with higher likelihood of T2DM remission

A population-based observational cohort study of >37,000 people in Hong Kong shows that greater weight loss within the first year of type 2 diabetes mellitus (T2DM) diagnosis is associated with an increased likelihood of achieving and sustaining diabetes remission.

“Clinical trials have demonstrated that remission of T2DM can be achieved following sustained weight loss. However, the feasibility of achieving diabetes remission through weight management in real-world settings remains unclear,” wrote the researchers from the Chinese University of Hong Kong (CUHK). [Lancet 2018;391:541-551; Lancet Diabetes Endocrinol 2020;8:477-489] “In this study, we aimed to examine the association of weight change at 1 year after T2DM diagnosis with long-term incidence and sustainability of diabetes remission in real-world settings in Hong Kong.” [PLoS Med 2024;doi:10.1371/journal.pmed.1004327]

Data were collected from 37,326 people newly diagnosed with T2DM in 2000–2017 who were enrolled in the territory-wide Risk Assessment and Management Programme for Diabetes Mellitus. Diabetes remission was defined as two consecutive HbA_1c values <6.5 percent measured ≥6 months apart in the absence of glucose-lowering drugs (GLDs) and with no record of GLD use ≥3 months before these measurements.

One year after T2DM diagnosis, 2.8 percent of people had a weight loss of ≥10 percent, 10.4 percent had a weight loss of 5–9.9 percent, 40.2 percent had a weight loss of 0–4.9 percent, and 46.6 percent experienced weight gain. “People with greater 1-year weight loss were more likely to be women, had higher blood pressure and lipid levels, were less likely to be current smokers and alcohol users, and were less likely to use GLDs at baseline,” noted the researchers.

During a median follow-up of 7.9 years, 6.1 percent of people achieved diabetes remission, with 88 percent of remission events occurring within the first 5 years of the follow-up. “The incidence of diabetes remission in our study was comparable to that in other epidemiological studies, but significantly lower than in clinical trials,” commented the researchers. [Diabetes Care 2014;37:3188-3195; Diabetes Care 2022;45:1151-1161]

The rate of diabetes remission was higher among those with greater weight loss. Specifically, 14.4 percent of people who lost ≥10 percent of their body weight achieved remission, vs 9.9 percent of those with 5–9.9 percent weight loss, and 6.5 percent of those with 0–4.9 percent weight loss. Interestingly, 4.5 percent of people who gained weight during the study period also achieved diabetes remission. Nevertheless, after adjusting for age at diabetes diagnosis, sex, assessment year, BMI, other metabolic indices, smoking, alcohol drinking, and medication use, the hazard ratio (HR) for diabetes remission was 3.28 (95 percent confidence interval [CI], 2.75–3.92; p<0.001) for people with ≥10 percent weight loss within 1 year of diagnosis, 2.29 (95 percent CI, 2.03–2.59; p<0.001) for those with 5–9.9 percent weight loss, and 1.34 (95 percent CI, 1.22–1.47; p<0.001) for those with 0–4.9 percent weight loss vs people with weight gain.

During a median follow-up of 3.1 years from the date of diabetes remission, 67.2 percent of people returned to hyperglycaemia. The median time to return to hyperglycaemia was 3.6 years. Greater weight loss 1 year after T2DM diagnosis was associated with a decreased risk of returning to hyperglycaemia. Compared with people who gained weight, adjusted HR for returning to hyperglycaemia was 0.52 (95 percent CI, 0.41–0.65; p<0.001) for those with ≥10 percent weight loss, 0.78 (95 percent CI, 0.68–0.92; p=0.002) for those with 5–9.9 percent weight loss, and 0.90 (95 percent CI, 0.80–1.01; p=0.073) for those with 0–4.9 percent weight loss.