That losing weight (and then maintaining the weight loss) with a diet combined with healthier lifestyles can not only be good for you but can reverse a disease such as type 2 diabetes is something already demonstrated by many studies. But now another study, one of the first, shows with clear evidence that any remission of diabetes 2 due to weight loss also has very important additional advantages, because it leads to 40% less cardiovascular disease and 33% less disease chronic renal disease. Among the most frequent complications in patients with diabetes.
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The new study, led by Professor Edward Gregg, of the Irish University of Medicine and Medical Sciences, Dublin, and colleagues, published in Diabetology, the journal of Easd, the European Association for the Study of Diabetes, is among the first to demonstrate the impact of disease remission on cardiovascular outcomes. With a multicenter study – Look Ahead – which compared for 12 years the effect of intensive lifestyle interventions in patients with type 2 diabetes on cardiovascular diseases, for which these patients are most at risk.
The patients recruited
Conducted between 2001 and 2016, the study recruited and then randomly distributed 5145 overweight or obese adults (with BMI above 25 for those who did not use insulin and above 27 for those who used it) with type 2 diabetes, aged between 45 and 76 years old. The authors then conducted an observational analysis of participants in both groups classifying them based on remission and then comparing long-term outcomes based on remission and its duration for 12 years. In total they compared the incidence of cardiovascular disease and kidney failure in more than 4,000 participants.
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Let’s look at the identikit of the participants: 58% women, average age 59 years, average duration of the disease six years, average body mass 35.8 (severe obesity over 35). The authors applied the concept of remission in cases in which they were no longer taking diabetes medications and in which glycated hemoglobin was below 48mmol/mol (6.5%). As regards the definition of risk – high or very high – the researchers based themselves on the KDIGO criteria (Kidney Disease Improving Global Outcomes) recording every event of non-fatal heart attack, stroke, hospitalization for angina or death from a cardiovascular event.
And here are the results. Participants with clear disease remission during the observation period had a 33% lower risk of renal failure and 40% lower risk of cardiovascular disease, adjusting for glycated hemoglobin values, blood pressure, lipid profile, history cardiovascular, duration of diabetes. But these results were even better for those who had been in remission for longer.
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The authors of the study therefore highlighted three things. The first is that although 18% of participants achieved remission at some point in the study, this percentage had nevertheless decreased by 3% during the eighth year of the study, underscoring the difficulties of losing weight and staying lean with weight loss-style interventions. life. Second thing: despite the relatively short duration of most episodes of remission, each remission was still associated with the benefits observed, and indeed these benefits were proportional to the duration of the remission: those who managed to stay in remission from the disease for at least 4 years passed from 33 to 55% lower risk of renal failure and from 40 to 55 of cardiovascular failure. Finally, third element, participants with a short duration of the disease, a modest glycosylated hemoglobin and a large weight reduction had a greater chance of remission from the disease. And this result – according to the authors – can be explained by improvements in weight, greater movement, lower glycosylated hemoglobin and a reduction in LDL cholesterol, the bad cholesterol. “These results are encouraging for all those patients who can achieve a remission from type diabetes – he commented Edward Gregg-. And our study also reminds us that maintaining weight loss and remission is a difficult thing.”
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The study has another advantage. “It gives a positive message – he specifies Andrea Giaccari, diabetologist at the Gemelli Polyclinic Foundation in Rome – but the point is also how to predict remission. Because the conclusion of the study is that diet and activity reduce cardiovascular and renal risk only if in the meantime you go into remission of diabetes. Otherwise, drugs are better.”