title: Association of an intensive lifestyle intervention with remission of type 2 diabetes.
abstract: BACKGROUND
  The frequency of remission of type 2 diabetes achievable with lifestyle intervention is unclear.
  
  
  OBJECTIVE
  To examine the association of a long-term intensive weight-loss intervention with the frequency of remission from type 2 diabetes to prediabetes or normoglycemia.
  
  
  METHODS
  Ancillary observational analysis of a 4-year randomized controlled trial (baseline visit, August 2001-April 2004; last follow-up, April 2008) comparing an intensive lifestyle intervention (ILI) with a diabetes support and education control condition (DSE) among 4503 US adults with body mass index of 25 or higher and type 2 diabetes.
  
  
  METHODS
  Participants were randomly assigned to receive the ILI, which included weekly group and individual counseling in the first 6 months followed by 3 sessions per month for the second 6 months and twice-monthly contact and regular refresher group series and campaigns in years 2 to 4 (n=2241) or the DSE, which was an offer of 3 group sessions per year on diet, physical activity, and social support (n=2262).
  
  
  METHODS
  Partial or complete remission of diabetes, defined as transition from meeting diabetes criteria to a prediabetes or nondiabetic level of glycemia (fasting plasma glucose <126 mg/dL and hemoglobin A1c <6.5% with no antihyperglycemic medication). RESULTS Intensive lifestyle intervention participants lost significantly more weight than DSE participants at year 1 (net difference, -7.9%; 95% CI, -8.3% to -7.6%) and at year 4 (-3.9%; 95% CI, -4.4% to -3.5%) and had greater fitness increases at year 1 (net difference, 15.4%; 95% CI, 13.7%-17.0%) and at year 4 (6.4%; 95% CI, 4.7%-8.1%) (P < .001 for each). The ILI group was significantly more likely to experience any remission (partial or complete), with prevalences of 11.5% (95% CI, 10.1%-12.8%) during the first year and 7.3% (95% CI, 6.2%-8.4%) at year 4, compared with 2.0% for the DSE group at both time points (95% CIs, 1.4%-2.6% at year 1 and 1.5%-2.7% at year 4) (P < .001 for each). Among ILI participants, 9.2% (95% CI, 7.9%-10.4%), 6.4% (95% CI, 5.3%-7.4%), and 3.5% (95% CI, 2.7%-4.3%) had continuous, sustained remission for at least 2, at least 3, and 4 years, respectively, compared with less than 2% of DSE participants (1.7% [95% CI, 1.2%-2.3%] for at least 2 years; 1.3% [95% CI, 0.8%-1.7%] for at least 3 years; and 0.5% [95% CI, 0.2%-0.8%] for 4 years).
  
  
  CONCLUSIONS
  In these exploratory analyses of overweight adults, an intensive lifestyle intervention was associated with a greater likelihood of partial remission of type 2 diabetes compared with diabetes support and education. However, the absolute remission rates were modest. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00017953.
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA. edg7@cdc.gov
authors.forename: Edward W
authors.initials: EW
authors.lastname: Gregg
authors.forename: Haiying
authors.initials: H
authors.lastname: Chen
authors.forename: Lynne E
authors.initials: LE
authors.lastname: Wagenknecht
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: Clark
authors.forename: Linda M
authors.initials: LM
authors.lastname: Delahanty
authors.forename: John
authors.initials: J
authors.lastname: Bantle
authors.forename: Henry J
authors.initials: HJ
authors.lastname: Pownall
authors.forename: Karen C
authors.initials: KC
authors.lastname: Johnson
authors.forename: Monika M
authors.initials: MM
authors.lastname: Safford
authors.forename: Abbas E
authors.initials: AE
authors.lastname: Kitabchi
authors.forename: F Xavier
authors.initials: FX
authors.lastname: Pi-Sunyer
authors.forename: Rena R
authors.initials: RR
authors.lastname: Wing
authors.forename: Alain G
authors.initials: AG
authors.lastname: Bertoni
mesh_terms: D000368:Aged; D001786:Blood Glucose; D015992:Body Mass Index; D003376:Counseling; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D004032:Diet; D015444:Exercise; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D050177:Overweight; D010353:Patient Education as Topic; D011615:Psychotherapy, Group; D012074:Remission Induction; D040242:Risk Reduction Behavior; D012944:Social Support; D016896:Treatment Outcome; D015431:Weight Loss
chemical_list: D001786:Blood Glucose