Only 6% of People Can Achieve Type 2 Diabetes Remission Via Weight Loss

• In a study of more than 37,000 people with diabetes, only 6% were able to achieve remission through weight loss.
• Two-thirds of people who achieved remission would eventually become hyperglycemic again.
• Significant weight loss, especially within the first year of diagnosis, was associated with the highest likelihood of remission and maintenance of healthy A1C levels.

Achieving remission of type 2 diabetes is possible through weight loss alone, but few are successfully able to do so — especially over the long term.

New research from Hong Kong now indicates just how difficult it is to achieve remission. But it also gives further insight into the health benefits of weight loss for diabetes patients.

A paper published January 23 in the journal PLOS Medicine found that out of a cohort of more than 37,000 people with diabetes, only 6% (2,279 people), achieved remission during an average follow-up period of 8 years. Type 2 diabetes remission is defined by the American Diabetes Association as having a blood sugar reading “lower than 6.5% measured at least three months after” stopping drugs that lower blood sugar.

Many of those who achieved remission would, over time, become hyperglycemic again.

“Maintaining long-term remission was difficult. Among those who achieved remission, about 20% of them returned to hyperglycaemia [high blood sugar] every year. The findings underscore the importance of early weight management in achieving diabetes remission as well as the importance of diabetes prevention,” Dr. Hongjian Wu, Phd, a Research Assistant Professor at the Chinese University of Hong Kong and author of the study, told Healthline.

“In some ways it’s a little bit depressing. A lot of people couldn’t attain remission, but then a lot of people also couldn’t attain a significant degree of weight loss either,” said Dr. Sun Kim, an Associate Professor of Endocrinology at Stanford Health. Kim wasn’t affiliated with the research.

Although type 2 diabetes is considered incurable, for some, being able to bring their blood sugar under control through weight loss and other lifestyle changes, without the use of drugs, is itself a positive.

More weight loss, higher likelihood of remission

Patients, who were able to lose more weight, were more likely to achieve remission and maintain it over the long term compared to those who gained weight, especially if they lost the weight close to the time of their initial diagnosis.

Individuals who lost 10% or more of their body weight within one year of their diagnosis were 3 times more likely to achieve remission. The less weight that patients lost in that first year, the less likely to achieve remission, with those who lost less than 5% of their body weight only 34% more likely to do so.

Achieving remission is an important health milestone. Researchers found that patients who achieved remission were at a 31% decreased risk of death over the duration of the follow-up period.

“Many similar studies have shown that type 2 diabetes mellitus remission is possible with multiple strategies that involve weight loss as it brings down blood glucose levels and improves insulin sensitivity, though this study appears to show that this effect is not as much in this population of patients,” said Dr. Peminda Cabandugama, a diabetes specialist at the Cleveland Clinic and spokesperson for The Obesity Society. Cabandugama wasn’t affiliated with the research.

The benefits of early and significant weight loss also carried over to long-term maintenance of remission. Compared to those with weight gain, those who lost 10% or more of their body weight had a 48% decreased risk of becoming hyperglycemic again, while patients who lost between 5-9.9% of body weight saw a 22% decreased risk.

Those who lost less than 5% of their body weight only saw a 10% decreased risk of returning to hyperglycemia compared to patients who had gained weight.

In total, about two-thirds of those who achieved remission eventually became hyperglycemic again over an average follow-up of 3 years.

Real World Implications

The study included more than 37,000 newly diagnosed type 2 diabetes patients from Hong Kong who were enrolled in a diabetes assessment program. Patients were enrolled between 2000-2017 and were followed-up an average of 8 years. The cohort was evenly split among men and women, with an average age of 56 years old.

According to the study authors, the population-based study gives a “real-world” snapshot of the likelihood of remission, compared to smaller, controlled trials that have investigated it.

However, Cabandugama cautions, “There may be issues with global generalizability of the study due to the patients mainly being Hong Kong Chinese as opposed to being a multi-center study involving multiple countries.”

That is to say that the findings will not necessarily be applicable to other peoples and countries due to health, lifestyle, socioeconomic, and other factors.

Nonetheless, the general message is clear: although type 2 diabetes remission is rare through weight loss alone, early and significant weight loss is an important factor in achieving that goal, as well as benefiting overall health.

“The good news is that you can reverse some of the abnormalities of diabetes, especially early on. But a lot of that is associated with the amount of weight that you can lose,” said Kim

Takeaway Note

A new study found that only 6% of patients with type 2 diabetes were able to achieve remission through weight loss.

This study defines remission of type 2 diabetes as two consecutive readings of A1C below 6.5%, at least six months apart, without the use of blood glucose-lowering drugs, including insulin.

Two-thirds of people who achieved remission would eventually become hyperglycemic again.

Significant weight loss (10% or more of body weight) within one year of a diabetes diagnosis greatly increased the likelihood that an individual would achieve remission.