Can type 2 diabetes mellitus (T2DM) achieve remission?

From the Guidelines

Type 2 Diabetes Mellitus Remission

Type 2 diabetes mellitus (T2DM) can indeed achieve remission, characterized by normoglycemia without the need for pharmacological therapy, in certain individuals who undergo intensive lifestyle interventions or receive specific treatments 1.

Key Factors for Remission

The key factors that contribute to T2DM remission include:

• Weight loss: A weight loss of more than 10% of baseline body weight is associated with a higher chance of remission 1.
• Intensive lifestyle interventions: These interventions include a calorie-restricted diet and regular physical activity, which can lead to significant improvements in glycemic control and remission rates 1.
• Dietary changes: Certain diets, such as total diet replacement (TDR) and very low-calorie diets (VLCD), have been shown to be effective in achieving remission 1.
• Physical activity: Regular physical activity, such as moderate-to-vigorous physical activity for more than 150 minutes per week, is recommended for the prevention and control of T2DM 1.

Remission Rates

Remission rates can vary depending on the intervention and population being studied. For example:

• The Diabetes Remission Clinical Trial (DiRECT) reported a remission rate of 54% at 1 year with a total diet replacement program 1.
• A systematic review of trials of diets for diabetes remission reported a remission rate of 11% with meal replacement and 15% with a Mediterranean diet 1.

Conclusion is not allowed, so the answer will be ended here, but some important points are:

• Early intervention: Remission should be attempted as early as possible from diabetes diagnosis 1.
• Individualized approach: A personalized approach to lifestyle interventions and dietary changes is essential for achieving remission 1.
• Monitoring and maintenance: Regular monitoring and maintenance of lifestyle changes are crucial for sustaining remission 1.

From the FDA Drug Label

The percentage of patients who discontinued due to ineffective therapy was 5.4% in the liraglutide injection 1.8 mg + metformin treatment group, 3. 3% in the liraglutide injection 1.2 mg + metformin treatment group, 23.8% in the placebo + metformin treatment group, and 3.7% in the glimepiride + metformin treated group. At the end of the run-in period, 498 patients (50%) achieved HbA1c <7% with liraglutide injection 1. 8 mg and metformin and continued treatment in a non-randomized, observational arm.

Remission of Type 2 Diabetes Mellitus (T2DM):

• The term "remission" is not explicitly defined or mentioned in the provided drug label.
• However, the label does mention that 50% of patients achieved HbA1c <7% with liraglutide injection 1.8 mg and metformin, which could be interpreted as a significant improvement in glycemic control.
• No conclusion can be drawn regarding the achievement of remission in T2DM patients based on the provided information 2.

From the Research

Type 2 Diabetes Mellitus Remission

• Type 2 diabetes mellitus (T2DM) remission is achievable through lifestyle interventions, including diet and physical activity 3, 4.
• Studies have shown that intensive lifestyle interventions can lead to significant weight loss, improved quality of life, and reduced blood glucose levels, resulting in diabetes remission 3, 4, 5, 6.
• The effectiveness of lifestyle interventions for diabetes remission is influenced by factors such as the type and duration of the intervention, as well as the individual's baseline characteristics, including the duration of T2DM and the level of glycemic control 4, 5, 6.
• Medical strategies, including the use of glucose-lowering medications, can also contribute to diabetes remission, particularly when combined with lifestyle interventions 5, 6.
• The concept of T2DM remission is evolving, and it is now recognized that substantial intentional weight loss can lead to remission in almost nine out of ten people with T2DM, with improvements in all features of the metabolic syndrome 7.
• Dietary approaches, including weight loss of >10-15 kg, can improve HbA1c levels and potentially result in remission, particularly in individuals with short-duration T2DM, lower HbA1c levels, and a low requirement for glucose-lowering medications 7.

Factors Influencing Remission

• Duration of T2DM: Remission is more likely in individuals with short-duration T2DM 4, 5, 6, 7.
• Level of glycemic control: Individuals with lower HbA1c levels are more likely to achieve remission 4, 5, 6, 7.
• Weight loss: Substantial intentional weight loss is a key factor in achieving remission 3, 4, 5, 6, 7.
• Lifestyle interventions: Diet and physical activity are essential components of lifestyle interventions that can lead to remission 3, 4.
• Medical strategies: The use of glucose-lowering medications, particularly when combined with lifestyle interventions, can contribute to remission 5, 6.